Acute Bioprosthetic Mitral Valve Thrombosis: An Unfortunate Collision of Prothrombotic Risk Factors
Subclinical and clinical thrombosis of bioprosthetic cardiac valves is more common than has been previously recognized. We present a unique case of acute thrombosis of a bioprosthetic mitral valve in a 40-year-old female patient undergoing hormonal stimulation as part of in vitro fertilization therapy, who also had concomitant protein C deficiency that was undiagnosed at the time. To the best of our knowledge, this is the first reported case of acute bioprosthetic valve thrombosis in this complex thrombophilic milieu, and suggests the need for increased screening for prothrombotic risk factors in female patients with bioprosthetic valves before they commence gonadotropin stimulation therapy.
Abazid RM, Shoman M, Smettie OA, Elamin OA. 2018. Human menopausal gonadotropin-induced bioprosthetic valve thrombosis. Avicenna J Med 8:114-6.
Basra SS, Gopal A, Hebeler KR, et al. 2018. Clinical leaflet thrombosis in transcatheter and surgical bioprosthetic aortic valves by four-dimensional computed tomography. Ann Thorac Surg 106:1716-25.
Egbe AC, Pislaru SV, Pillikka PA, et al. 2015. Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors. J Am Coll Cardiol 66:2285-94.
Gurunath S, Vinekar S, Biliangady R. 2018. Assisted reproductive technologies in a patient with a history of venous thromboembolism: a case report and review of literature. J Hum Reprod Sci 11:193-7.
Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. 2017. Systematic review of worldwide trends in assisted reproductive technology 2004-13. Reprod Biol Endocrinol 15:6.
Nishimura RA, Otto CM, Bonow RO, et al. 2017. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol 70:252-89.
Puri R, Auffret V, Rodes-Cabau J. 2017. Bioprosthetic valve thrombosis. J Am Coll Cardiol 69:2193-211.
Sachdev S, Bardia N, Nguyen L, Omar B. 2018. Bioprosthetic valve thrombosis. Cardiol Res 9:335-42.
Sennström M, Rova K, Hellgren M, et al. 2017. Thromboembolism and in vitro fertilization – a systematic review. Acta Obstet Gynecol Scand 96:1045-52.
Toner JP, Coddington CC, Doody K, et al. 2016. Society for Assisted Reproductive Technology and assisted reproductive technology in the United States: a 2016 update. Fertil Steril 106:541-6.