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. 2020 Dec 12;4(6):1-4.
doi: 10.1093/ehjcr/ytaa474. eCollection 2020 Dec.

Acute myocardial infarction associated with prosthetic valve leaflet thrombosis after transcatheter aortic valve implantation: a case report

Johannes Rotta Detto Loria  1 , Holger Thiele  1 , Mohamed Abdel-Wahab  1
Affiliations

Acute myocardial infarction associated with prosthetic valve leaflet thrombosis after transcatheter aortic valve implantation: a case report

Johannes Rotta Detto Loria et al. Eur Heart J Case Rep. .

Abstract

Background: Fatal thrombo-embolic events like cerebral stroke or myocardial infarction are rare complications of prosthetic heart valve leaflet thrombosis. Nevertheless, prevention and management of leaflet thrombosis is gaining increased attention, particularly with the widespread adoption of transcatheter heart valves.

Case summary: We herein present the case of a 79-year-old man who had undergone a transcatheter aortic valve implantation procedure. Seven months later, he presented with a non-ST-segment elevation myocardial infarction. Coronary angiography did not reveal obstructive lesions. A dedicated cardiac computed tomography scan showed thrombosis of both right- and non-coronary leaflets of the prosthetic aortic valve, while prosthetic valve function was normal on echocardiography. Transmural myocardial infarction lesions in the midventricular and apical inferior wall were detected by cardiac magnetic resonance imaging.

Discussion: Subclinical leaflet thrombosis of prosthetic aortic valves is a common finding. In this case report, we show that myocardial infarction presumably due to leaflet thrombosis was the first symptom in an otherwise asymptomatic patient. This finding raises the question of the validity in distinguishing between subclinical and clinical leaflet thrombosis based on prosthetic valve function.

Keywords: Aortic stenosis; Case report; MINOCA; Myocardial infarction; TAVI; Valve thrombosis.

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Figures

Figure 1
Figure 1
Dedicated cardiac computed tomography scan with leaflet thrombosis in an Acurate neo L transcatheter valve. White arrow indicating the right coronary cusp, black arrow indicating the non-coronary cusp. (A) axial plan and (B) coronal plane.
Figure 2
Figure 2
Cardiac magnetic resonance imaging with subendocardial to transmural late gadolinium enhancement. (A) and (B) Short-axis stack with late gadolinium enhancement of the mid-ventricular inferior wall and apex (white arrows). (C) Long-axis stack four chamber view and (D) STIR-sequence short-axis stack with oedema (white circle) of the mid-ventricular inferior wall.
None
See this image and copyright information in PMC

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