Mechanical Prosthetic Aortic Valve Thrombosis Complicated by an Acute Coronary Syndrome During Fibrinolysis

Joe Aoun; Jean-Pierre Assaker; Nadeen Faza; Neal S Kleiman; Nadim Zacca; Stephen H Little

doi:10.1016/j.jaccas.2020.08.029

Mechanical Prosthetic Aortic Valve Thrombosis Complicated by an Acute Coronary Syndrome During Fibrinolysis

JACC Case Rep. 2020 Nov 4;2(14):2186-2190. doi: 10.1016/j.jaccas.2020.08.029. eCollection 2020 Nov 18.

Authors

Joe Aoun¹, Jean-Pierre Assaker², Nadeen Faza¹, Neal S Kleiman¹, Nadim Zacca¹, Stephen H Little¹

Affiliations

¹ Department of Cardiovascular Medicine, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas.
² Department of Internal Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts.

Abstract

A 70-year-old man with mechanical aortic and mitral valves was admitted with progressive shortness of breath. He was found to have thrombosis of the aortic valve prosthesis. Treatment with intravenous thrombolysis was complicated by an acute coronary syndrome related to coronary embolism. The patient was successfully managed conservatively with long-term anticoagulation. An algorithm for the management of coronary embolism is suggested. (Level of Difficulty: Advanced.).

Keywords: ACS, acute coronary syndrome; AV, aortic valve; DVI, dimensionless valve index; INR, international normalized ratio; LAD, left anterior descending; NYHA, New York Heart Association; PVT, prosthetic valve thrombosis; TEE, transesophageal echocardiogram; TIMI, Thrombolysis In Myocardial Infarction; TTE, transthoracic echocardiogram; acute coronary syndrome; aortic valve; coronary embolism; fibrinolysis; left-sided prosthetic valve thrombosis; mitral valve; t-PA, tissue-type plasminogen activator; thrombolysis; thrombus.

Publication types

Case Reports