title: Thrombus formation following transcatheter aortic valve replacement.
abstract: OBJECTIVE
  This paper reviews the published data and reports 3 cases of thrombosis involving CoreValve (Medtronic, Minneapolis, Minnesota) and 1 involving Edward Sapien (Edwards Lifesciences, Irvine, California) devices. Three of these cases had pathological findings at autopsy.
  
  
  BACKGROUND
  Only a limited number of cases of valve dysfunction with rapid increase of transvalvular aortic gradients or aortic insufficiency post-transcatheter aortic valve replacement (TAVR) have been described. This nonstructural valvular dysfunction has been presumed to be because of early pannus formation or thrombosis.
  
  
  METHODS
  Through reviews of the published reports and 4 clinical cases, pathological and clinical findings of early valve thrombosis are examined to elucidate methods for recognition and identifying potential causes and treatments.
  
  
  RESULTS
  This paper presents 4 cases, 2 of which had increasing gradients post-TAVR. All 3 pathology cases showed presence of a valve thrombosis in at least 2 TAV leaflets on autopsy, but were not visualized by transthoracic echocardiogram or transesophageal echocardiogram. One case was medically treated with oral anti coagulation with normalization of gradients. The consequence of valve thrombosis in all 3 pathology patients either directly or indirectly played a role in their early demise. At least 18 case reports of early valve thrombosis have been published. In 12 of these cases, the early treatment with anticoagulation therapy resolved the thrombus formation and normalized aortic pressures gradients successfully.
  
  
  CONCLUSIONS
  These 4 cases elucidate the occurrence of valve thrombosis post-TAVR. Consideration should be given to treatment with dual antiplatelet therapy and oral anticoagulation in patients post-TAVR with increasing mean pressure gradients and maximum aortic valve velocity. Further research should be conducted to create guidelines for antithrombotic therapy following TAVR procedure.
authors.affiliation: International Medicine Institute, Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Eduardo
authors.initials: E
authors.lastname: De Marchena
authors.affiliation: International Medicine Institute, Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: jxm572@med.miami.edu.
authors.forename: Julian
authors.initials: J
authors.lastname: Mesa
authors.affiliation: International Medicine Institute, Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Sydney
authors.initials: S
authors.lastname: Pomenti
authors.affiliation: International Medicine Institute, Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Christian
authors.initials: C
authors.lastname: Marin Y Kall
authors.affiliation: International Medicine Institute, Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Ximena
authors.initials: X
authors.lastname: Marincic
authors.affiliation: CVPath Institute, Gaithersburg, Maryland.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Yahagi
authors.affiliation: CVPath Institute, Gaithersburg, Maryland.
authors.forename: Elena
authors.initials: E
authors.lastname: Ladich
authors.affiliation: CVPath Institute, Gaithersburg, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Kutz
authors.affiliation: International Medicine Institute, Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Yaar
authors.initials: Y
authors.lastname: Aga
authors.affiliation: Division of Cardiology, University of Virginia, Charlottesville, Virginia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.affiliation: Division of Cardiology, Iowa Heart Center, Des Moines, Iowa.
authors.forename: Atul
authors.initials: A
authors.lastname: Chawla
authors.affiliation: Division of Cardiology, Providence Spokane Heart Institute, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ring
authors.affiliation: CVPath Institute, Gaithersburg, Maryland.
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001344:Autopsy; D002114:Calcinosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011859:Radiography; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: antiplatelet therapy; thrombosis; transcatheter aortic valve replacement; valve-in-valve