Bioprosthesis leaflet thrombosis following self-expanding valve-in-valve transcatheter aortic valve replacement in patient taking factor Xa inhibitor and warfarin: A case report.
Bioprosthesis leaflet thrombosis following self-expanding valve-in-valve transcatheter aortic valve replacement in patient taking factor Xa inhibitor and warfarin: A case report.
- 2018
Available in print through MWHC library: 2002 - present
An 87-year-old female with symptomatic severe aortic stenosis underwent transcatheter valve replacement (TAVR) via the transfemoral approach with a 29mm self-expanding device. Moderate to severe paravalvular regurgitation led to the development of congestive heart failure and hospital readmission 1 month following TAVR. A second 29mm valve was placed to abolish the paravalvular regurgitation. Routine follow-up computed tomography (CT) imaging demonstrated leaflet thickening and decreased leaflet mobility suggesting valve thrombosis, despite adherence to Factor Xa inhibitor. Transthoracic echocardiogram revealed normal transaortic valve gradients. The patient was transitioned to a vitamin K antagonist and repeat imaging 3months later demonstrated progression of thrombosis to an additional leaflet. The case illustrates the potential increased risk of leaflet thrombosis in patients receiving valve-in-valve TAVR procedures, the superiority of multidetector computed tomography to image subclinical leaflet thrombosis, and highlights the need for further investigation in this area. Copyright (c) 2017 Elsevier Inc. All rights reserved.
English
1878-0938
*Anticoagulants/ad [Administration & Dosage]
*Aortic Valve Insufficiency/su [Surgery]
*Aortic Valve Stenosis/su [Surgery]
*Aortic Valve/su [Surgery]
*Bioprosthesis
*Factor Xa Inhibitors/ad [Administration & Dosage]
*Heart Valve Prosthesis
*Heart Valve Prosthesis Implantation/ae [Adverse Effects]
*Heart Valve Prosthesis Implantation/is [Instrumentation]
*Thrombosis/et [Etiology]
*Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
*Transcatheter Aortic Valve Replacement/is [Instrumentation]
*Warfarin/ad [Administration & Dosage]
Aged, 80 and over
Aortic Valve Insufficiency/dg [Diagnostic Imaging]
Aortic Valve Insufficiency/et [Etiology]
Aortic Valve Insufficiency/pp [Physiopathology]
Aortic Valve Stenosis/dg [Diagnostic Imaging]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Echocardiography, Doppler, Color
Echocardiography, Transesophageal
Female
Humans
Multidetector Computed Tomography
Risk Factors
Thrombosis/dg [Diagnostic Imaging]
Treatment Outcome
MedStar Heart & Vascular Instituteon
Journal Article
Available in print through MWHC library: 2002 - present
An 87-year-old female with symptomatic severe aortic stenosis underwent transcatheter valve replacement (TAVR) via the transfemoral approach with a 29mm self-expanding device. Moderate to severe paravalvular regurgitation led to the development of congestive heart failure and hospital readmission 1 month following TAVR. A second 29mm valve was placed to abolish the paravalvular regurgitation. Routine follow-up computed tomography (CT) imaging demonstrated leaflet thickening and decreased leaflet mobility suggesting valve thrombosis, despite adherence to Factor Xa inhibitor. Transthoracic echocardiogram revealed normal transaortic valve gradients. The patient was transitioned to a vitamin K antagonist and repeat imaging 3months later demonstrated progression of thrombosis to an additional leaflet. The case illustrates the potential increased risk of leaflet thrombosis in patients receiving valve-in-valve TAVR procedures, the superiority of multidetector computed tomography to image subclinical leaflet thrombosis, and highlights the need for further investigation in this area. Copyright (c) 2017 Elsevier Inc. All rights reserved.
English
1878-0938
*Anticoagulants/ad [Administration & Dosage]
*Aortic Valve Insufficiency/su [Surgery]
*Aortic Valve Stenosis/su [Surgery]
*Aortic Valve/su [Surgery]
*Bioprosthesis
*Factor Xa Inhibitors/ad [Administration & Dosage]
*Heart Valve Prosthesis
*Heart Valve Prosthesis Implantation/ae [Adverse Effects]
*Heart Valve Prosthesis Implantation/is [Instrumentation]
*Thrombosis/et [Etiology]
*Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
*Transcatheter Aortic Valve Replacement/is [Instrumentation]
*Warfarin/ad [Administration & Dosage]
Aged, 80 and over
Aortic Valve Insufficiency/dg [Diagnostic Imaging]
Aortic Valve Insufficiency/et [Etiology]
Aortic Valve Insufficiency/pp [Physiopathology]
Aortic Valve Stenosis/dg [Diagnostic Imaging]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Echocardiography, Doppler, Color
Echocardiography, Transesophageal
Female
Humans
Multidetector Computed Tomography
Risk Factors
Thrombosis/dg [Diagnostic Imaging]
Treatment Outcome
MedStar Heart & Vascular Instituteon
Journal Article