Rapidly progressive obstructive bioprosthetic valve thrombosis after surgical aortic valve replacement: a case report

TL;DR

A patient developed a dangerous blood clot on a heart valve replacement shortly after stopping anticoagulation, leading to cardiac arrest and requiring emergency surgery.

Contribution

This case report highlights the rapid progression and underappreciated risk of bioprosthetic valve thrombosis despite appropriate anticoagulation.

Findings

A patient experienced obstructive bioprosthetic valve thrombosis 113 days after aortic valve replacement.

The patient suffered cardiac arrest requiring extracorporeal cardiopulmonary resuscitation due to thrombus formation.

The case emphasizes the need for improved risk factor identification and preventive strategies for bioprosthetic valve thrombosis.

Abstract

Bioprosthetic valve thrombosis (BPVT) is an uncommon but potentially life-threatening complication following aortic valve replacement. The optimal management approach, whether surgical intervention or thrombolytic therapy, is controversial.

A 65-year-old male presented with exertional dyspnoea, and echocardiography confirmed severe aortic valve stenosis. Following minimally invasive aortic valve replacement with a bioprosthetic valve, the patient was discharged on postoperative Day 7 without complications. However, he returned on post-operative Day 113 with acute chest pain and dyspnoea, resulting in cardiac arrest that required extracorporeal cardiopulmonary resuscitation. Subsequent transoesophageal echocardiography revealed significant thrombus formation on the bioprosthetic valve, leading to reoperation and implantation of a new bioprosthetic valve.

This case illustrates the rapid progression to obstructive BPVT following discontinuation of anticoagulation therapy. It underscores the potential risk of BPVT despite appropriate anticoagulation. The incidence of BPVT may be underestimated, highlighting the necessity for further investigation into associated risk factors and preventive strategies. Acknowledging the unusual occurrence of BPVT, prompt diagnosis with echocardiographic screening and vigilant follow-up are essential to prevent severe complications such as rapid clinical deterioration and cardiac arrest.

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