Author + information
- Received November 27, 2012
- Accepted December 11, 2012
- Published online June 11, 2013.
- Dawn C. Scantlebury, MBBS,
- Vuyisile T. Nkomo, MD, MPH and
- Maurice Enriquez-Sarano, MD
A 28-year-old woman with a history of preeclampsia presented with symptomatic severe mitral regurgitation. Echocardiography revealed sessile thickening along the edges of both mitral leaflets (A, B,Online Video 1) suspicious for nonbacterial thrombotic endocarditis. She underwent mitral valve replacement with a bioprosthesis due to a wish for further childbearing. Gross appearance (C) and pathology confirmed nonbacterial thrombotic endocarditis, and positive serology confirmed antiphospholipid syndrome.
Post-operatively, the patient complied poorly with anticoagulation and 4 months later presented with recurrent dyspnea, restricted valve opening, bioprosthetic leaflet thrombi (D,Online Video 2), and 20-mm Hg transvalvular mitral gradient. Anticoagulation was reinitiated, with rapid symptomatic improvement, mitigating a need for re-operation. Later imaging (E) demonstrated resolution of the thrombi.
Antiphospholipid syndrome is a multisystem thrombotic disorder (1) causing preeclampsia and valvular thrombosis on both native and prosthetic valves, including bioprostheses, as demonstrated. Life-long anticoagulation is indicated. Bioprosthesis thrombosis resolution can be achieved by sustained anticoagulation without re-operation.
- Received November 27, 2012.
- Accepted December 11, 2012.
- American College of Cardiology Foundation