title: Non-obstructive prosthetic aortic valve thrombosis presenting with acute myocardial infarction and stroke in a patient with inadequate low-molecular-weight heparin treatment. The unlucky patient and the (pseudo)prudent physician.
abstract: Non-obstructive prosthetic valve thrombosis is a rare and underestimated complication in patients with left-sided mechanical heart valves. Systemic embolisation, mainly involving the cerebral circulation, often represents the first clinical manifestation. We report a case of multiple, successive embolizations in the coronary and cerebral circulation, presenting with an acute myocardial infarction and stroke in a patient with latent, non-obstructive thrombosis of a mechanical bileaflet aortic valve. Because of scheduled urological surgery, chronic vitamin K antagonist treatment had previously been discontinued and replaced with low-molecular-weight heparin, at inadequate dosage. Following coronary arteriography, brain computed tomography scan and transoesophageal echocardiography, thrombolysis was performed successfully. This case emphasises the utility of performing transoesophageal echocardiography routinely in the presence of ischaemic signs in patients with mechanical heart valves. In patients requiring discontinuation of oral anticoagulant therapy, accurate management and continuous monitoring of alternative medications are needed in order to avoid severe thromboembolic complications.
authors.affiliation: Division of Cardiovascular Diseases, S. Chiara Hospital, AOUP, and Universitaria Pisana, Pisa, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Paci
authors.forename: Fabio
authors.initials: F
authors.lastname: Lattanzi
authors.forename: Enrico
authors.initials: E
authors.lastname: Cabani
authors.forename: Umberto
authors.initials: U
authors.lastname: Conti
authors.forename: Salvatore Mario
authors.initials: SM
authors.lastname: De Tommasi
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001021:Aortic Valve / Q000601:surgery*; D004334:Drug Administration Schedule; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D004617:Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D019300:Medical Errors; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin