A rare case report of early bioprosthetic valve thrombosis presenting with acute heart failure salvaged by thrombectomy
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CASE REPORT
Open Access
A rare case report of early bioprosthetic valve thrombosis presenting with acute heart failure salvaged by thrombectomy Jingya Fan1, Peng Teng1, Yu Zou1 and Liang Ma1,2*
Abstract Background: Bioprosthetic valve thrombosis is previously considered as an extremely rare complication which hasn’t been systemically recognized and understood. Case presentation: Herein, we present an unusual case of a patient manifesting with acute heart failure, secondary to thrombus formation in a porcine aortic bioprosthesis which was implanted 11 months prior to hospitalization. Due to the patient’s poor heart function and intraoperative findings, thrombectomy was performed. For our best knowledge, cases of early bioprosthetic valve thrombosis presenting with acute heart failure have seldomly been reported. Conclusion: Our study reviews predisposing factors, typical echocardiographic features and treatment for bioprosthetic valve thrombosis and it should be considered as a reason for bioprosthetic malfunction. A combination of clinical and echocardiographic features can help for diagnosis preoperatively. In some certain circumstances, early reoperation can be avoided if anticoagulant therapy works. Keywords: Bioprosthetic valve thrombosis, Aortic valve, Thrombectomy, Porcine bioprosthesis
Backgound Bioprosthetic valve is advantageous over mechanical valve as its avoidance of long-term anticoagulation and low incidence of thromboembolic events. As a result, bioprosthetic valves are being implanted with ever-increasing frequency. However, according to previous study, the reported incidence of bioprosthetic valve thrombosis (BPVT) on routine echocardiographic surveillance is approximately 6% [1]. Thus, once anticoagulant treatment has been withdrawn, BPVT should be considered as a potential cause of prosthetic malfunction. Here we present a rare case requiring early reoperation for BPVT on aortic position which can provide us a better understanding of BPVT. Case presentation A 61-year old Chinese male presented with recurrent chest discomfort on exertion for 3 months and one episode of presyncope on exertion one day before referred * Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China 2 Postal Address: 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China
to our hospital. 11 months ago, the patient had received aortic valve replacement, because of congenital bicuspid aortic valve, with a 21-mm Hancock II porcine bioprosthesis (Medtronic, Inc, Minneapolis, MN, USA) implanted following the protocol provided by the manufacturer. Postoperative transthoracic echocardiography (TTE) showed normal function of bioprosthesis and he made an uneventful postoperative hospital course. The patient was discharged on 10th postoperative day and was on anticoagulation therapy with warfarin (target international normalized ratio (INR): 1.8-2.5) for 6 months. He continued to follow up at our hospital postoperatively. A
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