# Recurrent Embolic Strokes in Mechanical Aortic Valve: Diagnostic and Management Challenges

## TL;DR

A patient with a mechanical aortic valve had repeated strokes with no clear cause, leading to a rare diagnosis of valve thrombosis and successful treatment.

## Contribution

Highlights the diagnostic challenges and management of rare mechanical valve thrombosis causing recurrent strokes.

## Key findings

- Recurrent strokes occurred despite inconclusive tests and subtherapeutic anticoagulation.
- Fluoroscopy and CT revealed leaflet opening restriction, leading to surgical confirmation of valve thrombosis.
- Valve replacement and left atrial appendage occlusion resulted in no further events at 8-month follow-up.

## Abstract

Recurrent embolic strokes without an identifiable source in patients with mechanical heart valves pose a significant diagnostic challenge.

A 59-year-old woman with a mechanical aortic valve experienced recurrent embolic strokes, the first nearly 7 years after implantation during subtherapeutic anticoagulation. Repeated neurologic and cardiac imaging, thrombophilia screening, and prolonged rhythm monitoring failed to identify a definitive embolic source. Fluoroscopy and computed tomography showed discrete leaflet opening restriction. Multifocal infarctions raised clinical suspicion for mechanical valve thrombosis, prompting surgical exploration that confirmed diagnosis. The valve was replaced with a bioprosthesis, and left atrial appendage occlusion was performed. The patient remained event-free at 8-month follow-up.

Mechanical valve thrombosis is rare and often undetectable. This case highlights the diagnostic dilemma and importance of multidisciplinary team evaluation.

Recurrent embolic strokes in mechanical valve patients with inconclusive testing should prompt multidisciplinary evaluation and consideration of valve replacement.