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

• Published in: Diagnostics (Basel) Vol. 14; no. 18; p. 2070
• Main Authors: Muszyński, Paweł, Grunwald, Oliwia, Południewski, Maciej, Kralisz, Paweł, Kocańda, Szymon, Hirnle, Tomasz, Dobrzycki, Sławomir, Kożuch, Marcin
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 19.09.2024; MDPI
• 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; Poland; ViV TAVI; vascular complication; cardiovascular imaging; aortic dissection; valve thrombosis
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics14182070

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.