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Gepubliceerd in: Netherlands Heart Journal 4/2022

Open Access 04-02-2022 | Heart Beat

Bioprosthetic mitral valve thrombosis

Auteurs: S. Bouwmeester, M. el Farissi, P. Houthuizen

Gepubliceerd in: Netherlands Heart Journal | Uitgave 4/2022

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Extras
Video 1 Echogenic mass attached to mitral bioprosthesis
Video 2 Gradual decrease of echogenic mass under oral anticoagulant therapy
Video 3 Gradual decrease of echogenic mass under oral anticoagulant therapy
Opmerkingen

Video online

The online version of this article contains 3 videos. The article and the videos are online available (https://​doi.​org/​10.​1007/​s12471-022-01659-x).
An 80-year-old woman presented with an ischaemic stroke one year after an uneventful bioprosthetic mitral valve replacement. Transthoracic echocardiography was of suboptimal image quality; however, Doppler interrogation of the mitral valve revealed a markedly elevated transvalvular gradient (Fig. 1a). Transoesophageal echocardiography showed a large, mobile mass, which was attached to the mitral bioprosthesis and mimicked a ‘thumbs-up sign’ (Fig. 1b; see also Video 1 in the Electronic Supplementary Material). As the patient was afebrile and both blood cultures and 18FDG PET/CT imaging were negative, bioprosthetic valve thrombosis (BPVT) was considered a more likely diagnosis than endocarditis. Patient was declined for surgery because of the high operative risk. Alternatively, treatment with a warfarin derivate was initiated. Follow-up echocardiography showed a gradual decrease of the echogenic structure size over time (Fig. 1c, d; see also Videos 2 and 3 in the Electronic Supplementary Material), with normalization of the transvalvular gradient.
Clinicians should be aware of BPVT, especially in a patient who presents with a thromboembolic event. Prompt echocardiographic evaluation is essential for the diagnosis of BPVT. Symptomatic BPVT is rare, occurring in < 1% of patients undergoing surgical valve implantation. Symptomatic BPVT with a large thrombus (≥ 1.0 cm) requires urgent intervention. In general, surgery is the preferred treatment for symptomatic BPVT. However, fibrinolysis or oral anticoagulants should be considered in high–surgical risk patients.

Conflict of interest

S. Bouwmeester, M. el Farissi and P. Houthuizen declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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Supplementary Information

Video 1 Echogenic mass attached to mitral bioprosthesis
Video 2 Gradual decrease of echogenic mass under oral anticoagulant therapy
Video 3 Gradual decrease of echogenic mass under oral anticoagulant therapy
Metagegevens
Titel
Bioprosthetic mitral valve thrombosis
Auteurs
S. Bouwmeester
M. el Farissi
P. Houthuizen
Publicatiedatum
04-02-2022
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 4/2022
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-022-01659-x

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