Unexpected mechanical bileaflet valve thrombosis in mitral position: what is better to do, re-replacement or thrombolysis.
OBJECTIVE
The longevity of the mechanical heart valve prosthesis is an advantage when compared with its biological counterpart, although the former carries a risk of thrombosis depending on valve design, materials and host-related interface; therefore, a patient with a mechanical valve prosthesis, particularly in mitral position, is at risk for systemic thromboembolism even when properly anticoagulated.


METHODS
We report a case of a 60-year-old woman who underwent a mitral valve replacement with a St. Jude Medical (SJM) standard bileaflet mechanical heart valve.


RESULTS
On the twelfth post-operative day a primary thrombosis with blockage of the anterior valve leaflet occurred.


CONCLUSIONS
Aware of the risk of recurrent thromboembolism in this special clinical framework and possible cerebral bleeding in case of thrombolysis, we replaced the prosthesis with a new biologic porcine valve, the SJM Biocor.
Bottio
T
T
Department of Cardiovascular Surgery "V.Gallucci", University of Padua, Medical School, Via Giustiniani, 2, 35128 Padova, Italy. tomaso.bottio@unipd.it
Gerosa
G
G
Basso
C
C
Thiene
G
G
Casarotto
D C
DC
D000208:Acute Disease; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000601:surgery*; D018579:Patient Selection; D012008:Recurrence; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000150:complications; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*