Thrombosis of mitral annulus as an early complication following mechanical replacement of mitral and aortal valves: case report
Authors:
I. Andršová; T. Novotný; A. Floriánová; J. Maňoušek
Authors‘ workplace:
Interní kardiologická klinika LF MU a FN Brno-Bohunice
Published in:
Kardiol Rev Int Med 2011, 13(2): 117-119
Category:
Case report - competitive
Overview
Introduction:
The case report describes the occurrence of a postoperative thrombotic complication of the valve apparatus in an efficiently anti-coagulated patient without any known haematological disorder.
Abstract:
On 18 September 2008, a 61-year old patient had surgical replacement of the aortal and mitral valves with mechanical prostheses due to degenerative disease. Three weeks after the surgery the patient developed neurological symptoms of transient ischemic attack (TIA) on the right-hand side, for which the patient was admitted to the Department of Neurology. The following day TIA recurred. The patient was afebrile, with an initial CRP value of 30 mg/l; based on the INR value measured by the outpatients’ department, the patient was efficiently warfarinized with an initial INR value of 3.33. Echocardiography of the oesophagus was indicated, which revealed the presence of a 4 × 7 mm formation in the area of the mitral annulus. The patient was transferred to our department. Anti-coagulation therapy was accentuated and antibiotics started to be administered. While carefully monitoring INR (which did not drop below 3.2), control echocardiography was performed after 10 days, which revealed thrombosis progression. Considering the repeatedly negative hemocultures, the stable CRP value and the absence of other symptoms of infection, the condition was evaluated as a coagulation disorder with an unlikely occurrence of infective endocarditis. The basic haematological examination was normal. Following consultations with a cardiac surgeon and haematologist, it was decided to apply systemic thrombolysis after an adequate haematological preparation. The intervention did not cause any complications and both the thrombi were fully dissolved. The patient was discharged after 10 days with an efficient anti-coagulation therapy supported by anti-aggregation. A month after performing systemic thrombolysis, a control echocardiography was carried out by the outpatients’ department, which did not reveal any pathological intracardiac formations.
Conclusion:
Thrombotic complications regarding artificial valves in efficiently warfarinized patients are rare and their cause remains unclear in many cases.
Keywords:
artificial valves – thromboembolic disease – thrombolysis – anticoagulation – antiaggregation
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Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
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