Obstructive Bioprosthetic Mitral Valve Thrombosis

Abstract

Bioprosthetic valve thrombosis (BPVT) is not uncommon but can be under diagnosed due to the lack of awareness and technical limitations of echocardiography. When suspecting BPVT, it is imperative to consider multimodality imaging to establish the diagnosis as early treatment can alter the clinical course. Here we present a case series of two patients with a history of rheumatic heart disease status post bioprosthetic mitral valve replacement who presented with acute heart failure symptoms. In both cases, supplemental imaging with real-time 3D echocardiography was critical in establishing a diagnosis of BPVT, resulting in timely treatment. These cases support updating current guidelines for the management of patients with bioprosthetic valve replacement to include more frequent surveillance imaging even if patients are asymptomatic.

An uncommon case of bioprosthetic mitral valve thrombosis with subsequent prosthesis dehiscence

“…BVT is uncommon, occurring in 6.0–12.7% of patients with bioprosthetic valves. 2 Although the majority of cases remain subclinical and are only discovered incidentally on routine TTE, patients can present with symptoms and signs consistent with heart failure or cardiogenic shock due to mechanical obstruction. Patients can also present with signs suggestive of embolism, such as in our case, possibly due to delayed thrombus organisation.…”