Acute coronary embolism without valve thrombosis in a patient with a prosthetic mitral valve--successful percutaneous

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Mehmet Yazici1, Mehmet Kayrak, Yasar Turan

  • 1Selcuk University, Cardiology Department, Konya, Turkey. myazici61@hotmail.com <myazici61@hotmail.com>

The Heart Surgery Forum
|June 30, 2007
PubMed

Insights

A patient experienced myocardial infarction from a mitral valve prosthesis clot, despite no visible thrombus. Prompt percutaneous coronary intervention restored blood flow, highlighting a treatment for coronary embolism.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Mitral valve prostheses require adequate anticoagulation to prevent thromboembolic events.
  • Suboptimal anticoagulation can lead to complications such as stroke or myocardial infarction.

Observation:

  • A 44-year-old female presented with anterior myocardial infarction.
  • Coronary angiography revealed left anterior descending artery occlusion, attributed to embolization from her mitral valve prosthesis.
  • Despite suboptimal anticoagulation, initial echocardiography showed no prosthetic valve thrombus or dysfunction.

Findings:

  • Percutaneous transluminal coronary angioplasty and stenting successfully restored coronary artery perfusion.
  • The patient's chest pain resolved immediately post-intervention.
  • Follow-up echocardiography, including transesophageal echocardiography, confirmed no prosthetic valve thrombus.

Implications:

  • Coronary embolism can occur from prosthetic valves even without detectable thrombus or dysfunction, particularly with suboptimal anticoagulation.
  • Percutaneous coronary intervention is an effective treatment for acute coronary embolism in this context.
  • This case underscores the importance of vigilant anticoagulation monitoring in patients with prosthetic heart valves.

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