Mechanical Mitral Valve Thrombosis With Preserved Disc Mobility Uncovered by Cardiac CT: A Case Report

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Prosthetic valve thrombosis (PVT) is a life-threatening complication of mechanical valve replacement, traditionally diagnosed by TEE, fluoroscopy, and cardiac CT. We present a case of mechanical PVT despite intact disc mobility which was detected and monitored by cardiac CT. CASE A 67-year-old female with rheumatic heart disease and subsequent mechanical mitral and aortic valve replacement presented for 3 weeks of dyspnea. Initial workup was notable for a subtherapeutic INR and echocardiography showing a mean gradient of 10 mmHg across the mitral prosthesis, doubled from two months prior. DECISION-MAKING Given the mitral gradient increase and lack of recent coronary evaluation, fluoroscopy was deferred in favor of cardiac CT with morphology and coronary assessment. It revealed a 5.98 x 6.31 x 15.2 mm thrombus on the posterior mitral prosthesis with normal disc mobility (Figure 1). Slow-infusion tPA was initiated but discontinued after 8 hours due to left-sided hemiplegia; CT head demonstrated ischemic stroke requiring mechanical thrombectomy. Repeat cardiac CT showed thrombus reduction, and anticoagulation was restarted with heparin. CONCLUSION This case demonstrates the unique ability of cardiac CT to visualize PVT despite normal disc mobility, which would not have been detected by fluoroscopy alone. The non-invasiveness of cardiac CT compared to TEE also reinforces its utility as a standalone tool for both evaluation and follow-up of PVT.

Volume

87

Issue

13 Suppl

First Page

A1801

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1802

DOI

10.1016/j.jacc.2026.02.4498

Link to Full Text

Share

COinS