Huge prosthetic mitral valve thrombosis in a pregnant woman
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CitationÖzkan, M., Biteker, M., Ekşi Duran, N. ve Yıldız, M. (2009). Huge prosthetic mitral valve thrombosis in a pregnant woman. Circulation. 120(18), s. 151-152.
A 42-year-old woman in her 30th week of pregnancy who had undergone a mitral valve replacement with a 29-mm St. Jude Medical mechanical prosthetic valve (St. Jude Medical, St. Paul, Minn) 2 years earlier was referred to our hospital with severe dyspnea. She had a history of irregular and subtherapeutic use of enoxaparin 6000 IU/d until admission. Transthoracic echocardiography revealed a mean diastolic mitral transvalvular gradient of 29 mm Hg, mitral valve area of 0.6 cm2, and a giant thrombus with mobile components on the prosthetic valve (Figure 1; online-only Data Supplement Movie I). In spite of the large prosthetic mitral valve thrombosis, she had no history of thromboembolism. Two-dimensional transesophageal echocardiography revealed an unprecedentedly large thrombus (6 cm2 in area) appended to the mitral valve that was restricting the movement of 1 of the leaflets (Figure 2; online-only Data Supplement Movie II). Real-time 3-dimensional transesophageal echocardiography demonstrated restriction of 1 of the leaflets with a thrombus located on the left atrial side of the mitral valve (Figure 3; online-only Data Supplement Movie III). After the patient was given a low-dose (25 mg), slow-infusion (6 hours) tissue plasminogen activator without bolus administration 3 times (for a total of 75 mg), 3-dimensional transesophageal echocardiography showed complete thrombolysis (Figure 4; online-only Data Supplement Movie IV). The mean transprosthetic mitral valve gradient decreased to 4 mm Hg, and mitral valve area increased to 2.7 cm2.
- Makale Koleksiyonu