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A Very Late Mitral Valve Hypoattenuated Leaflet Thickening With Significant Warfarin Response
Mariam Almasri1, Alan Wong1, Puvi Seshiah1
1The Christ Hospital Health Network, Cincinnati, Ohio, USA.
Background:
Hypoattenuated leaflet thickening (HALT) represents subclinical leaflet thrombosis in bioprosthetic valves with risk of occurrence peaking at 12 to 24 months after implantation. However, late presentations can occur.
Case Summary:
A 77-year-old woman developed severe mitral stenosis 17 years after receiving a bioprosthetic mitral valve. Cardiac CT revealed extensive hypoattenuated leaflet thrombosis affecting all leaflets. After 3 months of therapeutic warfarin, repeat imaging demonstrated significant HALT resolution, avoiding valve-in-valve intervention.
Discussion:
This represents an unusual late HALT presentation, causing bioprosthetic mitral valve dysfunction, which exceeds usual follow-up periods. The significant response to warfarin supports anticoagulation effectiveness and thrombotic etiology.
Take-Home Messages:
Since HALT can occur very late after valve replacement, long-term monitoring needs to be considered. Warfarin anticoagulation can effectively resolve HALT even in late presentations, helping to avoid surgical intervention.
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