A Rare Case of Aortic Valve Thrombosis in Patient with Idiopathic Hypereosinophilic Syndrome

Abstract

Idiopathic hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and eosinophil-mediated organ-system damage. Cardiac thrombosis and thromboembolic complications represent common causes of morbidity and mortality and usually involve cardiac ventricles or mitral and prosthetic valves, while the involvement of the aortic valve is extremely rare in HES. Here we report peculiar multimodality images of an atypical case of extended thrombosis of the aortic valve, complicated by myocardial ischemia and asymptomatic cerebral ischemia, likely due to thrombus embolization, occurring in a 48-year-old man with HES. Prompt anticoagulant and steroid therapy lead to rapid and complete resolution of the thrombotic lesions, allowing preserving the native valve and preventing further embolic events.

Figure 1

Thrombotic obliteration of the right and no-coronary Valsalva sinuses in systole (a) and diastole (b) in the upper transesophageal short axis view. Floating thrombi attached to the aortic side of the right and no-coronary Valsalva sinuses, extended to the corresponding cusps in diastole (c) and systole (d), in the upper transesophageal long axis view. (e) Cardiac MRI image showing thrombotic mass attached to the aortic valve (arrow). (f) Multiple cortical-subcortical ischemic lesions in the right frontal lobe, at the cerebral MRI.