Journal of Cardiology and Heart Failure
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ABSTRACT
Background
Prosthetic Valve Thrombosis (PVT) is a life-threatening complication, particularly when involving left-sided mechanical valves. Coronary embolism secondary to PVT is exceedingly rare and poses a diagnostic and therapeutic challenge. Guidelines recommend urgent surgery, but options are limited in patients with unstable blood pressure or who are inoperable.
Keywords: Prosthetic valve thrombosis, coronary embolism, stuck mechanical valve, tenecteplase, aspiration thrombectomy, off-label thrombolysis, valve-related STEMI.
Case Summary
We present a rare case of a 50-year-old male with a history of double mechanical valve replacement on chronic warfarin therapy, who presented with symptoms of acute anterior STEMI. He was found to have a stuck aortic valve due to thrombus formation, with embolization into the left anterior descending artery (LAD) causing coronary obstruction. The patient was hemodynamically unstable (BP 90/60 mmHg) and had a subtherapeutic INR of 1.1. Surgery was deemed too high-risk. Full-dose tenecteplase was administered (⅓ intracoronary, ⅔ intravenous), followed by multiple aspiration catheter runs. The patient’s condition rapidly stabilized, with restoration of LAD patency and full valve mobility. No stents were used. Follow-up on day 3 showed complete thrombus resolution. He was discharged on day 4 on optimized anticoagulation.
INTRODUCTION
Mechanical prosthetic heart valves are widely used to treat advanced valvular heart disease; however, they carry lifelong risks, particularly related to thromboembolic events. A “stuck valve” refers to the mechanical obstruction of a prosthetic valve, most commonly caused by thrombus formation or fibrous pannus tissue, leading to restricted leaflet mobility and impaired cardiac function. Among those, thrombotic obstruction is the most common, accounting for up to 78% of cases, while pannus alone is responsible for about 10%, and a combination of both in another 10–12% [1].
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