Interv Akut Kardiol. 2007;6(5):195-199

An unusual case of thrombosis after the replacement of the aortic valve with a bioprosthesis

Jana Matoušková¹, Petr Niederle¹, Miroslava Benešová², Iva Zemanová³, Miloš Táborský¹

¹ Kardiologické oddělení, Nemocnice Na Homolce, Praha

² Kardiochirurgické oddělení Nemocnice Na Homolce, Praha

³ Patologické oddělení Nemocnice Na Homolce, Praha

This is the case of a 69 year old woman who died of heart failure as a result of the rapid progression of thrombotic obstruction of the aortic bioprosthesis less than two months after surgery. We discuss the problems with the use of bioprostheses, particularly whether anti-coagulation should be administered during the post-operative period and the therapeutic options in the event of thrombosis.

Generally, in low-risk patients (i.e. those with no prior history of thromboembolism, hypercoagulation, atrial fibrillation, findings of thrombi in the heart chambers, left atrium > 55 mm or dysfunction of the left ventricle with EF < 30 %) aortic bioprostheses have the lowest thrombogenic potential of all valve replacements. Normally bioprostheses do not require long-term anti-coagulation therapy and the administration of acetyl-salicylic acid is generally sufficient, however there is no single opinion on the need for anti-coagulation during the first three months after the implant.

The occurrence of thrombosis of aortic bioprosthetic valve is extremely rare and this is the first ever case in our centre. It is a very serious complication, leading to obstruction of the valve, sometimes accompanied by its incompetence. The clinical signs depend on the speed with which the thrombosis occurs – when the thrombus grows slowly the patient experiences progressive dyspnoea and fatigue, while acute thrombosis rapidly leads to severe heart failure and sudden death. The main diagnostic tool is the echocardiogram. Treatment is either surgical – reoperation of the valve, or systemic thrombolytic therapy.

We emphasize the need to carefully evaluate the risk of thrombo-embolism in each patient. The need for anti-coagulation in the post-operative period will be based on risk assessment. It is necessary to monitor regularly the patient’s condition in order to intercept any initial symptoms of thrombosis. This is the task not only of the cardiologist and cardiac surgeon, but also of the general practitioner.

Keywords: valve prosthesis, aortal bioprosthesis, thrombosis

Published: January 16, 2008  Show citation