Coronary embolism following aortic and mitral valve replacement: successful management with abciximab and urokinase

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Prosthetic heart valves, such as St. Jude aortic and mitral valve replacements, can be associated with embolic complications.
• Coronary embolism is a rare but serious cause of acute myocardial infarction.

Observation:

• A 63-year-old woman with St. Jude aortic and mitral valve replacements presented with acute myocardial infarction.
• Cardiac catheterization revealed a saddle embolus in the circumflex and ramus arteries and another embolus in a diagonal branch.

Findings:

• Angioplasty was performed for the occluding diagonal branch embolus.
• A combined regimen of intracoronary urokinase and intravenous abciximab achieved complete resolution of the coronary emboli.

Implications:

• This case highlights a successful treatment strategy for coronary embolism in patients with prosthetic heart valves.
• The findings suggest that a combination of interventional and pharmacological approaches can effectively manage this critical condition.
• Further research may explore optimal anticoagulation and thrombolytic strategies in this patient population.