The Aortic Prosthesis and Aortic Valve Bioprosthesis Trombosis as a Late Complication in Patients after the Bentall Procedure Followed by a Valve-in-Valve Transcatheter Aortic Valve Implantation

Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for structural valve degeneration following surgical aortic valve replacement (SAVR) or prior TAVI. However, the understanding of long-term complications and their management remains limite...

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Published in:Diagnostics (Basel) 2024-09, Vol.14 (18), p.2070
Main Authors: Muszyński, Paweł, Grunwald, Oliwia, Południewski, Maciej, Kralisz, Paweł, Kocańda, Szymon, Hirnle, Tomasz, Dobrzycki, Sławomir, Kożuch, Marcin
Format: Article
Language:English
Subjects:
Anticoagulants
aortic dissection
Apixaban
Aspirin
Blood clot
Blood clots
Cardiac patients
Cardiovascular disease
cardiovascular imaging
Care and treatment
Coronary vessels
Dissection
Heart attacks
Implants, Artificial
Informed consent
Interesting Images
Patients
Prostheses
Prosthesis
Thromboembolism
Thrombosis
valve thrombosis
vascular complication
ViV TAVI
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Summary:Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for structural valve degeneration following surgical aortic valve replacement (SAVR) or prior TAVI. However, the understanding of long-term complications and their management remains limited. We present the case of a 69-year-old male with a history of ViV-TAVI, who presented with symptoms of non-ST elevation myocardial infarction (NSTEMI) and transient ischemic attack (TIA). Computed tomography (CT) revealed thrombosis of the ascending aortic graft and aortic valve prosthesis. Transthoracic echocardiography (TTE) further confirmed new valve dysfunction, indicated by an increase in the aortic valve mean gradient. Treatment with low-molecular-weight heparin (LMWH) resulted in partial thrombus resolution. The multidisciplinary Heart Team opted against coronary angiography and recommended the long-term administration of vitamin K antagonists (VKAs). Follow-up CT showed the complete resolution of the thrombus. Thrombosis of the aortic graft and aortic valve following ViV-TAVI may be attributed to alterations in blood flow or mechanical manipulations during the TAVI procedure, yet it can be effectively managed with VKA therapy. CT is a valuable tool in coronary assessment in patients with NSTEMI and aortic valve and/or aortic graft thrombosis.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics14182070