Clin Ultrasound.  2016 Nov;1(2):120-125. 10.18525/cu.2016.1.2.120.

Acute Prosthetic Mechanical Mitral Valve Thrombosis Following Open Cholecystectomy

• Lee JS
• Yang HS

• KMID: 2555390
• DOI: http://doi.org/10.18525/cu.2016.1.2.120

Abstract

A 61-year-old woman was referred for chest discomfort 7 days after successful open cholecystectomy. She has had a prosthetic mechanical mitral valve for 10 years and been on warfarin medication since then. Her preoperative cardiac work-up showed good mechanical valve function with optimal prothrombin time international normalized ratio levels. However, anticoagulation was inadequate during the immediate postoperative period, and subsequent echocardiograms revealed a newly developed thrombus with one leaflet fixation. Having an acute thrombus with New York Heart Association functional class I-II and a strong reluctance to re-do open heart surgery, fibrinolytic therapy was performed. Acute bleeding from a pseudoaneurysm of the right hepatic artery interrupted the intravenous alteplase infusion and required emergency coil embolization. Ultimately, the mechanical click sound resumed, and a subsequent echocardiogram revealed successful resolution of the acute thrombus and restored mechanical mitral valve prosthesis function.

Keyword

인공 판막; 혈전; 혈전용해술; Heart valve prosthesis; Thrombosis; Thrombolytic therapy