Exercise testing induces fatal thromboembolism from mechanical mitral valve.
Thromboembolism is still one of the most important complications of prosthetic heart valves. Embolism to a major coronary branch is rare, but acute proximal occlusions can be fatal, even when the coronary arteries are otherwise normal and intervention is rapid. We report a fatal complication of an exercise test in a patient who had a St. Jude bileaflet mitral valve. After an exercise test, a 42-year-old woman with a mechanical prosthetic valve had a severe hemodynamic collapse with acute ST segment changes. Coronary angiography showed a totally occluded left main coronary artery with TIMI grade 0 to 1 flow. Rapid injection of contrast material and the passage of a floppy guidewire through the thrombus restored a TIMI grade 3 flow. Angiography showed no coronary atherosclerostic involvement. Despite successful coronary reperfusion, intra-aortic balloon counterpulsation, and intensive medication, the patient died. This case demonstrates that exercise testing should be applied with great caution in patients with prosthetic valves, and only after a careful evaluation of valve function. We recommend transesophageal echocardiography prior to exercise testing in these patients.
Yavuzgil
Oguz
O
Ege University, Medical Faculty, Department of Cardiology, Izmir, Turkey.
Ozerkan
Filiz
F
Gurgun
Cemil
C
Zoghi
Mehdi
M
Can
Levent
L
Akin
Mustafa
M
D000328:Adult; D003328:Coronary Thrombosis / Q000209:etiology*; D005080:Exercise Test / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008943:Mitral Valve; D013923:Thromboembolism / Q000209:etiology*