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Thrombus in the distal aortic arch after apicoaortic conduit for severe aortic stenosis

Shinsuke Kotani1, Koji Hattori, Yasuyuki Kato

  • 1Department of Cardiovascular Surgery, Osaka City General Hospital, Miyakojima, Osaka, Japan. m1155424@med.osaka-cu.ac.jp

Interactive Cardiovascular and Thoracic Surgery
|December 17, 2009
PubMed

Insights

Thrombogenesis occurred in the aortic arch after apicoaortic conduit surgery despite warfarin. Immediate anticoagulation is recommended post-surgery to prevent blood clots, even with bioprosthetic valves.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Severe aortic stenosis (AS) often necessitates surgical intervention.
  • Apicoaortic conduit (AAC) surgery is an alternative for patients with complex aortic calcification.
  • Bioprosthetic valves are commonly used in AAC procedures.

Observation:

  • A 71-year-old woman developed a distal aortic arch thrombus post-AAC surgery for severe AS.
  • Computed tomography (CT) and cine magnetic resonance imaging (MRI) confirmed the thrombus and indicated blood flow stagnation.
  • The thrombus significantly reduced in size by six months post-surgery.

Findings:

  • Apicoaortic conduit surgery can lead to thrombogenesis in the aortic arch, potentially due to altered blood flow dynamics.
  • Blood flow patterns may evolve over time following AAC procedures.
  • Delayed antegrade flow through the native aortic valve was observed one year post-surgery.

Implications:

  • Early initiation of postoperative anticoagulant therapy is crucial, irrespective of bioprosthetic valve use.
  • Close monitoring for thrombotic events is warranted after AAC surgery.
  • Understanding blood flow changes post-AAC is vital for optimizing patient management and preventing complications.

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