Circulation. 2008;118:e705
doi: 10.1161/CIRCULATIONAHA.108.786228
(Circulation. 2008;118:e705.)
© 2008 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Fluoroscopy of Acutely Thrombosed Aortic Valve
A. Ravandi, MD, PhD;
J.C.J. Sun, MD, MSc;
A. Lamy, MHSc, MD;
N. Valettas, MASc, MD
From the Division of Cardiology (A.R., N.V.) and Division of Cardiac Surgery (J.C.J.S., A.L.), McMaster University, Hamilton, Ontario, Canada.
Correspondence to Amir Ravandi, MD, PhD, Division of Cardiology, McMaster University, Hamilton General Hospital, 237 Barton St E, Hamilton, ON L8L 2X2, Canada. E-mail ravanda{at}mcmaster.ca
A 75-year-old woman with a prior history of aortic valve replacement with a St. Jude Medical mechanical bileaflet prosthesis presented to an outside hospital with an intracranial hemorrhage. Her anticoagulation was reversed with Vitamin K therapy and she was transferred to our center for tertiary neurosurgical care. On day 10 of her admission, she developed new left-sided hemiparesis, and a computed tomography head scan confirmed a middle cerebral artery territory infarct. Physical examination revealed a harsh systolic ejection murmur, and a transthoracic echocardiogram performed to rule out a cardiac source for emboli revealed a severely stenotic mechanical aortic valve with a peak gradient of 146 mm Hg and a mean gradient of 88 mm Hg with moderate aortic insufficiency (Figure 1; online-only Data Supplement Movies I through III). The valve was also assessed by fluoroscopy (online-only Data Supplement Movies IV and V), which showed complete fixation of one leaflet and restricted mobility of the other, with an eccentric jet of aortic regurgitation. A filling defect was visualized around the nonmobile leaflet, highly suggestive of thrombus. Intraoperatively, a large thrombus was visualized around the valve (Figure 2). Fluoroscopy continues to be a simple and accurate method for both diagnosis and follow up of St. Jude valve thrombosis.1 In conjunction with 2-dimensional echocardiography, which can provide hemodynamic assessment of the valve, fluoroscopy is useful for assessing leaflet mobility.2
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Figure 1. Transthoracic 2-dimensional echocardiography showing severe stenosis of the mechanical aortic valve: average peak gradient of 146 mm Hg and mean pressure of 88 mm Hg.
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Figure 2. Intraoperative photo of the bileaflet mechanical valve as seen through an aortotomy. A large organized thrombus (T) obstructs the majority of the valve orifice. A small portion of the valve housing can still be seen (V).
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Disclosures
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None.
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Footnotes
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The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/118/22/e705/DC1.
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References
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1. Silber H, Khan SS, Matloff JM, Chaux A, DeRobertis M, Gray R. The St. Jude valve: thrombolysis as the first line of therapy for cardiac valve thrombosis.
Circulation. 1993; 87: 30–37.
[Abstract/Free Full Text]2. Czer LSC, Weiss M, Bateman TM, Pfaff JM, DeRobertis M, Eigler N, Vas R, Matloff JM, Gray RJ. Fibrinolytic therapy of St. Jude valve thrombosis under guidance of digital cinefluoroscopy. J Am Coll Cardiol. 1985; 5: 1244–1249.[Abstract]
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Disclosures
References