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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
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A Challenging Case of Mechanical Mitral Valve Obstruction
Biraj Shrestha1, Bidhya Poudel2, Tuoyo Mene-Afejuku3
1Internal Medicine, Reading Hospital Tower Health System, Reading, USA.
Cureus
|May 10, 2022
Summary
Prosthetic valve thrombosis (PVT) is a common mechanical valve complication. Cardiac CT imaging is crucial for differentiating thrombus from pannus, guiding treatment decisions for prosthetic valve dysfunction.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Prosthetic valve thrombosis (PVT) is a significant complication of mechanical heart valves, often presenting with heart failure or thromboembolic events.
- Antiphospholipid syndrome (APS) increases the risk of thrombosis, even after mechanical valve replacement, necessitating careful anticoagulation management.
Observation:
- A 45-year-old female with APS and a history of mitral valve thrombus presented with symptoms of mitral stenosis post-mechanical mitral valve replacement.
- Subtherapeutic warfarin (INR 1.8) and echocardiography findings of severe mitral stenosis with an immobile posterior leaflet were noted.
- Despite two trials of alteplase, valve leaflet mobility did not improve.
Findings:
- Cardiac CT revealed a small thrombus and pannus formation on the mitral valve ring.
- Distinguishing between thrombus (Hounsfield Unit <90) and pannus (Hounsfield Unit >145) using CT was key.
- The patient underwent successful re-operation for mechanical mitral valve replacement due to persistent immobility and suspected pannus.
Implications:
- This case highlights the diagnostic utility of cardiac CT in differentiating prosthetic valve thrombus from pannus, which have different management strategies.
- Accurate imaging is essential for guiding timely and appropriate interventions in patients with prosthetic valve dysfunction.
- Multidisciplinary decision-making is vital for optimizing patient outcomes in complex cardiovascular cases.
Keywords:
adult cardiac surgerymechanical prosthetic valve thrombosismitral valve diseasepannus formationsystemic thrombolysisMore Related Videos
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