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Bioprosthetic Aortic Valve Thrombosis and Literature Review

An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG;...

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Autores principales: Radovanovic, Milan, Nordstrom, Charles W., Hanna, Richard D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409674/
https://www.ncbi.nlm.nih.gov/pubmed/36005416
http://dx.doi.org/10.3390/jcdd9080252
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author Radovanovic, Milan
Nordstrom, Charles W.
Hanna, Richard D.
author_facet Radovanovic, Milan
Nordstrom, Charles W.
Hanna, Richard D.
author_sort Radovanovic, Milan
collection PubMed
description An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt to be due to either early bioprosthetic degeneration, pannus formation, or patient–prosthesis mismatch. An echocardiogram at the time of symptom development demonstrated significant flow acceleration through the aortic valve, mild regurgitation, and severely increased MG (48 mmHg) with prolonged acceleration time (AT, 140 msec). A trial of warfarin anticoagulation resulted in dramatic improvement after only 6 weeks with laminar flow through the AV, near-total resolution of regurgitation, and a decrease in MG to 14 mmHg and AT to 114 msec. These findings strongly suggest that BAV thrombosis was the predominant mechanism responsible for the longstanding high MG. Our case highlights that BAV thrombosis should be considered in the differential of elevated gradients regardless of the age of prosthesis, and that a trial of warfarin anticoagulation may be beneficial even if elevated gradients have been present for a prolonged period. Valvular gradients are often abnormal long before a formal diagnosis; however, these may reverse quickly with anticoagulation therapy.
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spelling pubmed-94096742022-08-26 Bioprosthetic Aortic Valve Thrombosis and Literature Review Radovanovic, Milan Nordstrom, Charles W. Hanna, Richard D. J Cardiovasc Dev Dis Case Report An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt to be due to either early bioprosthetic degeneration, pannus formation, or patient–prosthesis mismatch. An echocardiogram at the time of symptom development demonstrated significant flow acceleration through the aortic valve, mild regurgitation, and severely increased MG (48 mmHg) with prolonged acceleration time (AT, 140 msec). A trial of warfarin anticoagulation resulted in dramatic improvement after only 6 weeks with laminar flow through the AV, near-total resolution of regurgitation, and a decrease in MG to 14 mmHg and AT to 114 msec. These findings strongly suggest that BAV thrombosis was the predominant mechanism responsible for the longstanding high MG. Our case highlights that BAV thrombosis should be considered in the differential of elevated gradients regardless of the age of prosthesis, and that a trial of warfarin anticoagulation may be beneficial even if elevated gradients have been present for a prolonged period. Valvular gradients are often abnormal long before a formal diagnosis; however, these may reverse quickly with anticoagulation therapy. MDPI 2022-08-06 /pmc/articles/PMC9409674/ /pubmed/36005416 http://dx.doi.org/10.3390/jcdd9080252 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Radovanovic, Milan
Nordstrom, Charles W.
Hanna, Richard D.
Bioprosthetic Aortic Valve Thrombosis and Literature Review
title Bioprosthetic Aortic Valve Thrombosis and Literature Review
title_full Bioprosthetic Aortic Valve Thrombosis and Literature Review
title_fullStr Bioprosthetic Aortic Valve Thrombosis and Literature Review
title_full_unstemmed Bioprosthetic Aortic Valve Thrombosis and Literature Review
title_short Bioprosthetic Aortic Valve Thrombosis and Literature Review
title_sort bioprosthetic aortic valve thrombosis and literature review
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9409674/
https://www.ncbi.nlm.nih.gov/pubmed/36005416
http://dx.doi.org/10.3390/jcdd9080252
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