Mechanical Aortic Valve Thrombosis Presenting as Stemi
Document Type
Article
Publication Date
4-2-2024
Publication Title
Journal of the American College of Cardiology
Abstract
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
First Page
3006
Recommended Citation
El-Gammal A, Gaith H, Arshad K, Bonkowski T, Mozaffari, MA, Abu-Mahfouz, M et al [Egbe A]. Mechanical aortic valve thrombosis presenting as stemi. J Am Coll Cardiol. 2024 Apr 2;83(13):3006.
