Late failure of prosthetic heart value

Area of Science:

• Cardiology
• Biomedical Engineering
• Prosthetic Heart Valves

Background:

• Mitral valve replacement surgery is a common procedure for severe mitral regurgitation or stenosis.
• Mechanical heart valves, such as the Lillehei-Kaster prosthesis, offer durability but require lifelong anticoagulation.
• Late prosthetic valve thrombosis (PVT) remains a significant complication, particularly in mechanical valves.

Observation:

• A 20-year-old woman presented with symptoms suggestive of prosthetic valve dysfunction.
• Imaging revealed late thrombosis of a 22 mm Lillehei-Kaster mitral valve prosthesis.
• The patient was reportedly compliant with prescribed anticoagulation therapy.

Findings:

• Clinical diagnosis of dysfunction was challenging due to the Lillehei-Kaster prosthesis's radiolucent disc and lack of distinct acoustic signals.
• Thrombosis occurred despite therapeutic anticoagulation levels, indicating potential challenges in maintaining adequate anticoagulation for this specific prosthesis.
• The prosthetic valve exhibited significant dysfunction secondary to the thrombus formation.

Implications:

• This case highlights the potential for late thrombosis in Lillehei-Kaster mitral valve prostheses, even with adequate anticoagulation.
• The inherent design features of this prosthesis may complicate early clinical and echocardiographic detection of thrombosis.
• Early diagnostic cardiac catheterization should be considered in patients with suspected Lillehei-Kaster mitral valve dysfunction, especially when clinical signs are equivocal.