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[A case report of a thrombosed mitral prosthesis diagnosed by 111In-oxine platelets scintigraphy]
M Otaki1, M Kawashima, A Yamaguchi
1Department of Cardiovascular Surgery, National Ohsaka Hospital.
Insights
111In-oxine labeled platelets scintigraphy effectively detected thrombus in a prosthetic mitral valve, leading to timely intervention. This imaging technique aids in diagnosing suspected valve thrombosis when other methods are inconclusive.
Area of Science:
- Cardiovascular Imaging
- Nuclear Medicine
- Prosthetic Valve Thrombosis
Background:
- Prosthetic valve thrombosis is a serious complication after valve replacement surgery.
- Diagnosing prosthetic valve thrombosis can be challenging, especially when clinical and echocardiographic findings are equivocal.
Observation:
- A patient with a Björk-Shiley prosthesis experienced peripheral embolism and visual disturbances, raising suspicion of valve thrombosis.
- Standard cineradiography did not reveal evidence of a thrombosed valve, despite clinical suspicion.
Findings:
- 111In-oxine labeled platelets scintigraphy demonstrated localized "hot spots" indicative of thrombus formation in the mitral prosthetic valve position.
- Surgical replacement of the Björk-Shiley prosthesis revealed a small thrombus (10mm) with surrounding fresh thrombi in a valve orifice.
Implications:
- 111In-oxine labeled platelets scintigraphy is a valuable tool for detecting prosthetic valve thrombosis when conventional methods are insufficient.
- Early and accurate diagnosis of prosthetic valve thrombosis can prevent thromboembolic complications and guide appropriate treatment strategies.
Abstract:
The purpose of this report was to evaluate the efficacy of 111In-oxine labeled platelets scintigraphy for detection of thrombus in the prosthetic valve. A 50-year-old man underwent re-mitral valve replacement with a Björk-Shiley prosthesis because of malfunction of the xenograft in a previous operation. Almost one year later, this patient suffered from peripheral embolism and sight disturbance. There was no evidence of a thrombosed valve although it was suspected. Cineradiography showed the valve almost fully open, and there were no abnormal sounds when the valve closed. 111In-oxine labeled platelets scintigraphy was performed for the detection of thrombus in the mitral position. Hot areas of high quality in the scintigram were demonstrated in the mitral position. As a result, Björk-Shiley prosthesis was replaced with a Duromedics prosthesis. A small thrombus (10mm) surrounded by fresh tiny thrombi was found in a minor orifice of the Björk-Shiley prosthesis.