Complex cause of ischaemic stroke in patient after mitral bioprosthesis implantation- A case report

Abstract

We present the history of 60-years-old woman with mitral and aortic bioprosthesis that have been implanted together with left atrial appendage closure. The patient had been treated with VKA and low dose of acetylsalicylic acid since surgery. On 28th day of postoperative period an ischemic stroke occurred. In transoesophageal echocardiography we have discovered non-obstructive thrombosis of the artificial mitral annulus and a gap in left atrial appendage (LAA) patch. There was rapid outflow through the gap in LAA directing to mitral annulus in close proximity to visible thrombus. The pathologic flow might have had the contribution in thrombus mobilization and stroke occurrence. We have decided to change anticoagulation to low molecular weight heparin. In control echocardiography, during heparin therapy, thirteen days later, there was remarkable worsening of annulus thrombosis with multiple thrombi present. Re-exchange anticoagulation to warfarin yielded in almost complete resolution of thrombosis after eleven days. We decided to continue anticoagulation over recommended three months not only due to incident of thrombosis but also suspicion of history of atrial fibrillation and presence of disrupt-ed LAA patch.