Acute myocardial infarction associated with prosthetic valve leaflet thrombosis after transcatheter aortic valve implantation: a case report

Abstract

Background Fatal thrombo-embolic events like cerebral stroke or myocardial infarction are rare complications of prosthetic heart valve leaflet thrombosis. Nevertheless, prevention and management of leaflet thrombosis is gaining increased attention, particularly with the widespread adoption of transcatheter heart valves. Case summary We herein present the case of a 79-year-old man who had undergone a transcatheter aortic valve implantation procedure. Seven months later, he presented with a non-ST-segment elevation myocardial infarction. Coronary angiography did not reveal obstructive lesions. A dedicated cardiac computed tomography scan showed thrombosis of both right- and non-coronary leaflets of the prosthetic aortic valve, while prosthetic valve function was normal on echocardiography. Transmural myocardial infarction lesions in the midventricular and apical inferior wall were detected by cardiac magnetic resonance imaging. Discussion Subclinical leaflet thrombosis of prosthetic aortic valves is a common finding. In this case report, we show that myocardial infarction presumably due to leaflet thrombosis was the first symptom in an otherwise asymptomatic patient. This finding raises the question of the validity in distinguishing between subclinical and clinical leaflet thrombosis based on prosthetic valve function.

Hypoattenuated Leaflet Thickening-Associated Myocardial Infarction: A Rare Case Report and Literature Review

“…MI following prosthetic aortic valve leaflet thrombosis is a rare finding. After reviewing the literature here, we described a case of a 79-year-old male with NSTEMI who seven months post-TAVR underwent a cardiac CT scan that showed thrombosis of prosthetic aortic valve leaflets, although valve function was normal on echocardiography [7]. In a similar case, acute MI of the left main trunk was reported in an 81-year-old woman 15 months post-TAVR procedure; this patient completed six months of dual antiplatelet therapy (DAPT) and was on aspirin monotherapy.…”

“…HALT is usually associated with accelerated prosthetic valve degeneration and increased chances of possible fatal thromboembolic neurological events like a cerebrovascular accident (CVA), transient ischemic attack (TIA), and cardiac events like myocardial infarction (MI) [6]. A potentially direct association between TAVR and late coronary ischemic syndromes seems to exist [7]. Thus, this case report emphasizes the significance of early intervention to swiftly establish a diagnosis so that the appropriate course of treatment can be decided and implemented as needed.…”

Case report: acute myocardial infarction in the setting of acute transcatheter aortic valve thrombus

“…A cardiac CT scan revealed thrombosis of both the right and non-coronary leaflets of the valve. Cardiac MRI then showed evidence of transmural myocardial infarction ( 7 ).…”