Urgent mitral valve replacement after mechanical thrombectomy for ischemic stroke

Mitral valve replacement, or any major cardiac surgery, is usually delayed for a minimum of 6 weeks after a previous stroke, mainly to avoid recurrence, if not associated with infective endocarditis or aortic dissection. A 50-year-old lady, diagnosed with severe mitral stenosis with a large left atrial clot, had a sudden onset cerebrovascular accident (CVA) while awaiting surgery. Mechanical thrombectomy (MT) of large vessel M1 middle cerebral artery (MCA) occlusion was done, and after adequate neurological improvement, she was taken up for emergency mitral valve replacement within 12 h, because of hemodynamic instability leading to low cardiac output syndrome and to avoid the chance of future CVA due to large clot burden. A 23-mm mechanical mitral valve prosthesis was implanted, and the postoperative course was uneventful. She was discharged on the fifth postoperative day, with stable hemodynamics and no residual neurological deficit. She was asymptomatic with normal echocardiographic findings on 12 months' follow-up. Major cardiac surgery after MT for ischemic CVA may be a viable option, if indicated, provided post-MT neurological improvement is adequate.