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Exercise testing induces fatal thromboembolism from mechanical mitral valve
Oguz Yavuzgil1, Filiz Ozerkan, Cemil Gurgun
1Ege University, Medical Faculty, Department of Cardiology, Izmir, Turkey.
Texas Heart Institute Journal
|May 9, 2002
Summary
Exercise stress testing poses risks for patients with prosthetic heart valves, potentially causing fatal coronary artery occlusion. Careful valve assessment, including echocardiography, is crucial before such tests.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Thromboembolism is a significant complication associated with prosthetic heart valves.
- Coronary artery embolism from prosthetic valves is rare but can be rapidly fatal.
Observation:
- A 42-year-old woman with a St. Jude mechanical mitral valve experienced hemodynamic collapse during an exercise test.
- Coronary angiography revealed acute, complete occlusion of the left main coronary artery.
Findings:
- Successful reperfusion of the left main coronary artery was achieved via guidewire and contrast injection.
- Despite successful intervention and intensive medical support, the patient died.
Implications:
- Exercise testing in patients with prosthetic valves requires extreme caution and thorough pre-test valve function evaluation.
- Transesophageal echocardiography is recommended prior to exercise testing in this patient population to assess prosthetic valve function and reduce risks.