A 48-year-old man with rheumatic heart disease had aortic and mitral valve replacement with bileaflet Carbomedix valves. Two months later, he presented in shock with acute thrombosis of the mitral valve, which was replaced with another bileaflet valve in an emergency operation. Three months later, he complained of shortness of breath and was found on Doppler echocardiography to have impaired ventricular function and a calculated peak instantaneous gradient of 100 mm Hg through the prosthetic aortic valve. Fluoroscopy in the right anterior oblique projection (a, systolic frame; b, diastolic frame) showed an immobile anterior leaflet of the aortic prosthesis in a nearly closed position and restricted movement of the posterior leaflet. Systolic color-Doppler flow signal through the prosthetic valve in the horizontal-plane transesophageal echocardiogram (c and d) had an unusual semicircular shape, the blocked anterior leaflet remaining “colorless.” There was also mild aortic regurgitation through the posterior leaflet (not shown). The patient declined thrombolytic therapy, and in an effort to prevent another operation, he was treated in the intensive care unit with heparin. A week later, repeated fluoroscopy showed almost normal motion of the previously stuck anterior leaflet but no change in the restricted posterior leaflet. Ventricular function improved, but the valve remained stenotic, and the patient underwent reoperation. The excised valve shows small but firmly adherent thrombi around the leaflet hinges bilaterally, on both the aortic (e) and ventricular (f) sides of the valve. No hypercoagulation disorder was identified, and the patient is now on a combination of warfarin, aspirin, and dipyridamole.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
- Copyright © 1996 by American Heart Association