3. Thrombosis of mechanical valve prosthesis: a case report

Аннотация

Mitral valve prosthesis thrombosis is a rare but life-threatening complication associated with mechanical heart valves. It requires timely diagnosis and prompt intervention to prevent severe morbidity and mortality. We report the case with hemoptysis, severe dyspnea, and fever, two years after mechanical mitral valve replacement with a St. Jude Medical prosthesis. Despite consistent anticoagulation therapy, recent transition from warfarin to low-molecular-weight heparin during hospitalization for pneumonia may have contributed to prosthetic thrombosis. Echocardiography revealed significant mitral valve dysfunction with a mean pressure gradient of 45 mmHg and evidence of thrombus formation. Emergency surgery confirmed total prosthetic valve thrombosis and necessitated thrombectomy and replacement with a new mechanical valve. Postoperative recovery was uneventful, with improved hemodynamics and resolution of pulmonary edema. This case highlights the complexities of managing mechanical valve thrombosis in patients with multiple risk factors, including anticoagulation changes, atrial fibrillation, and recurrent pulmonary infections. The surgical approach remains the gold standard for treatment, though emerging evidence supports the potential role of thrombolysis in select cases. In conclusion, mitral valve prosthesis thrombosis represents a significant challenge requiring multidisciplinary management and strict anticoagulation monitoring, and the importance of developing standardized protocols for early diagnosis, anticoagulation management, and surgical intervention.