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Intermittent left coronary occlusion caused by native aortic valve thrombosis in a patient with protein S deficiency
Y Jobic1, K Provost, J M Larlet
1Department of Cardiology and Cardiac Surgery, Brest University Hospital, France.
Insights
A mobile aortic thrombus caused by protein S deficiency led to intermittent coronary obstruction and cardiogenic shock in a patient. Transesophageal echocardiography confirmed this rare cardiac event, highlighting a novel association.
Area of Science:
- Cardiology
- Hematology
- Vascular Surgery
Background:
- Aortic thrombosis is a rare condition.
- Protein S deficiency is a prothrombotic state.
- Coronary ostium obstruction can cause myocardial infarction and cardiogenic shock.
Observation:
- A 77-year-old woman presented with chest pain and cardiogenic shock.
- Transesophageal echocardiography revealed a mobile mass intermittently obstructing the left coronary ostium.
- Surgical resection identified the mass as an organized thrombus.
Findings:
- Histologic examination confirmed an organized thrombus.
- Coagulation studies revealed protein S deficiency.
- This case represents the first documented instance of aortic thrombosis linked to protein S deficiency.
Implications:
- This finding expands the clinical spectrum of protein S deficiency.
- Transesophageal echocardiography is a valuable tool for diagnosing coronary ostium obstruction.
- Early diagnosis and surgical intervention are crucial for managing such rare cardiovascular emergencies.
Abstract:
A 77-year-old woman presented with chest pain and cardiogenic shock. Transesophageal echocardiography showed a mobile mass occluding intermittently the left coronary ostium. The mass was surgically resected, and histologic examination revealed an organized thrombus. Coagulation study demonstrated a protein S deficiency. This is the first case of aortic thrombosis associated with protein S deficiency, and it is the first time that transesophageal echocardiography provided definite evidence that a mass can cause intermittent left ostium coronary obstruction.