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  • Complementary role of cardiac CT in the diagnosis and management of mechanical aortic valve thrombosis with a novel low-dose, ultraslow thrombolysis treatment strategy

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Case report
Complementary role of cardiac CT in the diagnosis and management of mechanical aortic valve thrombosis with a novel low-dose, ultraslow thrombolysis treatment strategy
  1. Jonathan Senior1,
  2. Luke Mahoney1,
  3. Nishant Gangil1 and
  4. Jamal Nasir Khan1,2
  1. 1Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  2. 2Faculty of Medicine, University of Warwick, Coventry, Coventry, UK
  1. Correspondence to Dr Jonathan Senior; jonathan.senior{at}nhs.net

Abstract

A 31-year-old man presented to our emergency department with a 3-day history of progressive breathlessness, fatigue and exertional angina. His history included a mechanical aortic valve replacement (mAVR) for rheumatic heart disease at age 19 years. He could no longer afford medication prescription costs and consequently had not taken oral anticoagulation for 2 months. Transthoracic echocardiography (TTE) demonstrated mechanical prosthetic valve obstruction (PVO) and severe left ventricular (LV) systolic dysfunction; however, valve visualisation was limited by mAVR-related artefact. The patient declined transoesophageal echocardiography. Valve haemodynamics failed to improve despite a prolonged course of parenteral anticoagulation. Multidetector cardiac CT scan was performed which confirmed prosthetic valve thrombosis. A novel low-dose, ultraslow thrombolysis regimen was administered to mitigate the associated bleeding and embolic stroke risk. The patient made an excellent recovery and was discharged on day 30, with repeat cardiac CT scan showing complete resolution of mechanical PVO and normalisation of valve and LV function on TTE.

  • cardiovascular medicine
  • valvular diseases
  • radiology
  • radiology (diagnostics)

https://doi.org/10.1136/bcr-2021-246996

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    Footnotes

    • Contributors The case was devised by JNK with the first draft written by JS and subsequently edited by JNK. Author LM assisted with the preparation of supporting figures to illustrate the article. NG oversaw the care of the patient and devised the novel treatment after careful review of the published literature. All authors approved the final edit prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.