Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report

BACKGROUND: Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve thrombosi...

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Autores principales: Ananda, Roshan A, Zhang, Zhihua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294337/
https://www.ncbi.nlm.nih.gov/pubmed/37365533
http://dx.doi.org/10.1186/s12872-023-03359-9
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author Ananda, Roshan A
Zhang, Zhihua
author_facet Ananda, Roshan A
Zhang, Zhihua
author_sort Ananda, Roshan A
collection PubMed
description BACKGROUND: Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve thrombosis (BPVT), but thromboembolic events are rare and mainly affect the cerebrovascular system. Coronary embolism is an extremely rare complication of BPVT. CASE PRESENTATION: A 64-year-old male presented with non-ST-Elevation myocardial infarction (NSTEMI) to an Australian regional health service. Three years ago, he had undergone Bentall procedure with bioprosthetic aortic valve replacement for severe aortic regurgitation and significant aortic root dilatation. Diagnostic coronary angiography revealed embolic occlusion of first diagonal branch in the absence of underlying atherosclerosis. Prior to NSTEMI presentation, the patient was clinically asymptomatic apart from the progressive increase in transaortic mean pressure gradient on transthoracic echocardiography which was first detected seven months after surgical aortic valve replacement. Transoesophageal echocardiography showed restrictions of the aortic leaflet opening but no evidence of mass or vegetation. After eight weeks of warfarin therapy, the raised aortic valve gradient returned to normal. Lifelong warfarin was prescribed, and patient remained clinically well at 39-month follow-up. CONCLUSION: We experienced a case of coronary embolism in a patient with probable BPVT. Reversible bioprosthetic valve hemodynamic deterioration after anticoagulation strongly supports the diagnosis in the absence of histopathology. Early moderate-to-severe hemodynamic valve deterioration warrants further investigations, including cardiac computed tomography and sequential echocardiography, to investigate for probable BPVT and consideration of timely anticoagulation initiation to prevent thromboembolic events. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-023-03359-9.
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spelling pubmed-102943372023-06-28 Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report Ananda, Roshan A Zhang, Zhihua BMC Cardiovasc Disord Case Report BACKGROUND: Coronary embolism is a relatively rare but important non-atherosclerotic cause of acute coronary syndrome, mainly caused by atrial fibrillation and mechanical heart valve thrombosis due to subtherapeutic anticoagulation. There have been increasing reports of bioprosthetic valve thrombosis (BPVT), but thromboembolic events are rare and mainly affect the cerebrovascular system. Coronary embolism is an extremely rare complication of BPVT. CASE PRESENTATION: A 64-year-old male presented with non-ST-Elevation myocardial infarction (NSTEMI) to an Australian regional health service. Three years ago, he had undergone Bentall procedure with bioprosthetic aortic valve replacement for severe aortic regurgitation and significant aortic root dilatation. Diagnostic coronary angiography revealed embolic occlusion of first diagonal branch in the absence of underlying atherosclerosis. Prior to NSTEMI presentation, the patient was clinically asymptomatic apart from the progressive increase in transaortic mean pressure gradient on transthoracic echocardiography which was first detected seven months after surgical aortic valve replacement. Transoesophageal echocardiography showed restrictions of the aortic leaflet opening but no evidence of mass or vegetation. After eight weeks of warfarin therapy, the raised aortic valve gradient returned to normal. Lifelong warfarin was prescribed, and patient remained clinically well at 39-month follow-up. CONCLUSION: We experienced a case of coronary embolism in a patient with probable BPVT. Reversible bioprosthetic valve hemodynamic deterioration after anticoagulation strongly supports the diagnosis in the absence of histopathology. Early moderate-to-severe hemodynamic valve deterioration warrants further investigations, including cardiac computed tomography and sequential echocardiography, to investigate for probable BPVT and consideration of timely anticoagulation initiation to prevent thromboembolic events. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-023-03359-9. BioMed Central 2023-06-26 /pmc/articles/PMC10294337/ /pubmed/37365533 http://dx.doi.org/10.1186/s12872-023-03359-9 Text en © Crown 2023 https://creativecommons.org/licenses/by/4.0/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/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Ananda, Roshan A
Zhang, Zhihua
Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_full Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_fullStr Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_full_unstemmed Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_short Coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
title_sort coronary embolism due to probable clinical bioprosthetic aortic valve thrombosis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294337/
https://www.ncbi.nlm.nih.gov/pubmed/37365533
http://dx.doi.org/10.1186/s12872-023-03359-9
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