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. 2017;3(1):15.
doi: 10.1186/s40981-017-0086-5. Epub 2017 Apr 17.

Unexpected bioprosthetic mitral valve thrombus during left ventricular assist device implantation

Tatsuyuki Imada  1 , Sho Carl Shibata  1 , Kenta Okitsu  1 , Yuji Fujino  1
Affiliations

Unexpected bioprosthetic mitral valve thrombus during left ventricular assist device implantation

Tatsuyuki Imada et al. JA Clin Rep. 2017.

Abstract

Acute bioprosthetic valve thrombosis can occur after surgery and sometimes cause hemodynamic instability and cardiogenic shock. Risk factors for bioprosthetic valve thrombosis are hypercoagulability, atrial fibrillation, atrial dilatation, low cardiac function, and lack of anticoagulation therapy. The authors present a case of severe mitral stenosis due to bioprosthetic valve thrombus. The patient was diagnosed with dilated-phase hypertrophic cardiomyopathy and underwent mitral valve replacement. He required venoarterial extracorporeal membrane oxygenation (VA-ECMO) due to extremely low cardiac output and was scheduled for left ventricular assist device (LVAD) implantation. Transesophageal echocardiographic examination before LVAD implantation revealed severe mitral stenosis due to bioprosthetic mitral valve thrombus, which was not detected by transthoracic echocardiography in the intensive care unit and contributed to the low cardiac function. The thrombus was removed through an unscheduled left atriotomy before LVAD implantation. The possibility of bioprosthetic valve thrombosis must be considered when the patient is dependent on VA-ECMO support. Early transesophageal echocardiographic examination of the bioprosthetic valve may be helpful and contribute to surgical decision-making.

Keywords: Bioprosthetic valve thrombosis; Mitral stenosis; Mitral valve replacement.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mid-esophageal four-chamber view showing compression of the right ventricle due to pericardial hematoma. LA left atrium, LV left ventricle, RV right ventricle
Fig. 2
Fig. 2
a Immobilization of the bioprosthetic mitral valve due to thrombus was observed. Left atrial spontaneous echo contrast was also seen. b The thrombus was obstructing transmitral inflow, as seen in the aliased flow pattern using color flow Doppler. LA left atrium, LV left ventricle
Fig. 3
Fig. 3
a Mid-esophageal long-axis view with continuous-flow Doppler showing a mean mitral pressure gradient of 20 mmHg, which suggests severe mitral stenosis. b Organized thrombus adhered to the bioprosthetic mitral valve
See this image and copyright information in PMC

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