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(Circulation. 2009;120:e151-e152.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Huge Prosthetic Mitral Valve Thrombosis in a Pregnant Woman

Mehmet Özkan, MD; Murat Biteker, MD; Nilüfer Eki Duran, MD; Mustafa Yldz, MD

From the Department of Cardiology, Kouyolu Kartal Heart and Research Hospital, Istanbul, Turkey.

Correspondence to Murat Biteker, MD, Kouyolu Kartal Heart and Research Hospital, Cardiology Department, Zeytinlik Caddesi, Emrah Sokak, 7/20, Atalar, Kartal, Istanbul, Turkey. E-mail murbit2@yahoo.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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.

View larger version (102K):   Figure 1. Transthoracic echocardiography revealed obstruction of the . . . [Full Text of this Article]