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Thrombotic prosthetic valve dysfunction requiring valve re-replacement after mitral valve replacement for caseous
Keishi Miyazawa1,2, Eriya Imai2, Ami Kodaira2
1Department of Anesthesia, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan.
Insights
Caseous calcification of the mitral annulus (CCMA) and hypereosinophilic syndrome (HES) increase thrombotic risk. This case suggests intensive anticoagulation is needed after mitral valve replacement in patients with CCMA and HES.
Area of Science:
- Cardiology
- Hematology
- Pathology
Background:
- Caseous calcification of the mitral annulus (CCMA) and hypereosinophilic syndrome (HES) are conditions associated with increased thrombotic risk.
- CCMA can lead to mitral regurgitation (MR), potentially requiring surgical intervention.
- The combined occurrence of CCMA and HES is rare, leaving the optimal anticoagulation strategy post-mitral valve replacement undefined.
Observation:
- A 64-year-old male patient presented with heart failure and severe MR secondary to CCMA and HES.
- The patient underwent mitral valve replacement with a mechanical valve.
- Prosthetic valve dysfunction due to thrombosis occurred despite standard anticoagulation, necessitating valve re-replacement with a bioprosthetic valve.
Findings:
- Standard anticoagulation was insufficient in a patient with combined CCMA and HES.
- Intensive anticoagulation may be necessary to mitigate the high thrombotic risk posed by the co-occurrence of CCMA and HES.
- The underlying mechanism linking eosinophilia to CCMA warrants further investigation.
Implications:
- This case highlights the need for tailored, potentially more intensive anticoagulation protocols in patients with CCMA and HES undergoing valve replacement.
- Further research is crucial to elucidate the relationship between eosinophilia and CCMA and to establish evidence-based anticoagulation guidelines.
Background:
Caseous calcification of the mitral annulus (CCMA) and hypereosinophilic syndrome (HES) are both associated with thrombotic tendencies. Caseous calcification of the mitral annulus may cause mitral valve regurgitation (MR), which may necessitate surgical intervention, depending on its severity. Given the absence of reported cases combining CCMA and HES, the optimal target range for anticoagulation therapy after mitral valve replacement remains to be established.
Case Summary:
A 64-year-old man with CCMA complicated by HES was admitted due to heart failure and severe MR. The patient underwent mitral valve replacement with a mechanical valve. Despite standard anticoagulation therapy, prosthetic valve dysfunction had developed because of thrombosis. Intraoperative transoesophageal echocardiography revealed a closed stuck valve, necessitating valve re-replacement. A bioprosthetic valve was selected.
Discussion:
In cases of CCMA complicated by HES, the target of anticoagulation therapy is unclear. This case demonstrated that more intensive anticoagulation is required because of the thrombogenic risk of CCMA and HES. The mechanism of calcification due to eosinophilia has been suggested, and the relationship between eosinophilia and CCMA remains a subject for future research.
