Leaflet thrombosis after transcatheter aortic valve implantation: a case report
DOI:
https://doi.org/10.6016/ZdravVestn.2893Keywords:
aortic stenosis, transcatheter aortic valve implantation, leaflet thrombosis, anticoagulant therapyAbstract
We herein report the case of a 80-year old man with symptomatic degenerative aortic stenosis (peak gradient 58 mmHg, mean gradient 38 mmHg, valve area 0.9 cm2) and haemodynamically significant left main coronary artery (LM) and anterior descending artery (LAD) stenosis with fractional flow reserve of 0.72. Because of the age and significant degenerative spine disorder, the patient refused open heart surgery. We first performed percutaneous coronary intervention (PCI) on the LM and LAD, which was followed by staged transcatheter aortic valve implantation (TAVI) with self- expandable device. There was no significant aortic regurgitation and mean aortic gradient was 12 mmHg. After 4 months, mean gradient increased to 23 mmHg and this was associated with worsening of the patient’s exercise capacity. Computed contrast-enhanced tomography of the aorta showed thrombosis of the left and non-coronary cusps with decreased leaflet mobility. Stents in the LM and LAD were widely patent without significant in-stent restenosis. Acetylsalicilic acid was stopped and coumadin added to clopidogrel. After 4 months, mean gradient was 9 mmHg. After additional 3 months of anticoagulat therapy, it was 12 mmHg. Oral anticoagulation was therefore stopped and acetylsalicylic acid restarted.
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