Mechanical Aortic Valve Thrombosis Presenting as STEMI

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: The clinical presentation of mechanical valve thrombosis ranges from asymptomatic to cardiogenic shock. Case: A 51-year-old female with a history of On-X mechanical aortic valve implanted three years prior and CAD presented with acute chest pain. On presentation she was hemodynamically stable. EKG showed a STEMI in the inferior leads. Emergent left heart catheterization showed previously known CTO of the right coronary artery with a patent left coronary system. Echocardiogram showed high aortic prosthesis velocity with prolonged acceleration time, consistent with prosthesis obstruction. Transesophageal echocardiogram showed an 8.5 x 7 mm thrombus at the aortic prosthesis with associated regurgitation. Decision-making: The patient remained hemodynamically stable and chest pain free after initial catheterization. After a multidisciplinary discussion, the patient received a low dose 24-hour thrombolytic infusion. Repeat transesophageal echocardiogram showed resolution of prosthesis insufficiency with persistent elevated gradient. A second 24-hour thrombolytic infusion was given and repeat transesophageal echocardiogram showed complete resolution of prosthesis obstruction. The patient was then discharged on warfarin. Conclusion: This case demonstrates an unusual presentation of mechanical valve thrombosis as STEMI without acute coronary obstruction and the utility of low-dose thrombolytic infusion in the management of large mechanical aortic valve thrombosis..

Volume

83

Issue

13 Suppl

First Page

3006

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)04996-9

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