Authors
Michael J McKenna, Conor McCaughey, Greg L Douglas, Charles McCreery, Niall T Mulvihill, Martin Quinn, James A Shand
Published in
JACC. Case reports. Pages 110750. Oct 16, 2026. Epub Oct 16, 2026.
Abstract
Severe bioprosthetic valve dysfunction presents a diagnostic challenge because distinguishing reversible leaflet thrombosis from structural valve degeneration may not be possible using echocardiography alone.
A patient with end-stage renal disease, previous bioprosthetic mitral and aortic valve replacement, and prior valve-in-valve transcatheter aortic valve replacement presented with heart failure and cardiogenic shock. Multimodality imaging demonstrated severe bioprosthetic mitral valve dysfunction with restricted leaflet motion, raising suspicion for leaflet thrombosis. Empiric intravenous unfractionated heparin was commenced while cardiac computed tomography was arranged. Computed tomography excluded hypoattenuated leaflet thickening and demonstrated severe leaflet calcification, confirming structural valve degeneration. After heart team discussion, transseptal valve-in-valve mitral replacement resulted in rapid hemodynamic and clinical recovery.
Serial multimodality imaging guided escalation from anticoagulation to definitive valve intervention.
Persistent prosthetic valve dysfunction after anticoagulation should prompt reassessment for structural valve degeneration. Transseptal valve-in-valve transcatheter mitral valve replacement is an effective treatment for selected high-surgical-risk patients.
PMID:
42886120
Bibliographic data and abstract were imported from PubMed on 16 Oct 2026.
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