Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2015; 3(9): 838-842
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.838
Horseshoe thrombus in a patient with mechanical prosthetic mitral valve: A case report and review of literature
Sanjay Mehra, Assad Movahed, Carlos Espinoza, Constantin B Marcu
Sanjay Mehra, Assad Movahed, Carlos Espinoza, Constantin B Marcu, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC 27834, United States
Author contributions: Mehra S and Marcu CB designed the research and identified the case reported; Mehra S and Espinoza C performed review of literature; Mehra S prepared manuscript; Movahed A and Marcu CB revised manuscript.
Conflict-of-interest statement: The Authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Assad Movahed, MD, FACC, FACP, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, United States. movaheda@ecu.edu
Telephone: +1-252-7444400
Received: March 23, 2015
Peer-review started: March 25, 2015
First decision: April 10, 2015
Revised: April 21, 2015
Accepted: June 4, 2015
Article in press: June 8, 2015
Published online: September 16, 2015
Processing time: 176 Days and 9.5 Hours
Abstract

Patients with prosthetic cardiac valves are at high risk for thromboembolic complications and need life long anticoagulation with warfarin, which can be associated with variable dose requirements and fluctuating level of systemic anticoagulation and may predispose to thromboembolic and or hemorrhagic complications. Prosthetic cardiac valve thrombosis is associated with high morbidity and mortality. A high index of suspicion is essential for prompt diagnosis. Transthoracic echocardiography, and if required transesophageal echocardiography are the main diagnostic imaging modalities. Medically stable patients can be managed with thrombolytic therapy and anticoagulation, while some patients may require surgical thrombectomy or valve replacement. We present a case report of a patient with prosthetic mitral valve and an unusually large left atrial thrombus with both thromboembolic and hemorrhagic complications.

Keywords: Thrombosis; Anticoagulation; Thrombolytic therapy; Transthoracic echocardiogram; Prosthetic valves; Transesophageal echocardiogram

Core tip: Patients with mechanical prosthetic cardiac valves require life long systemic anticoagulation. Maintaining therapeutic anticoagulation consistently is challenging, given the variable dose requirements with warfarin, especially with dietary changes and drug interactions. We present a case of a patient with fluctuating control of anticoagulation, which led to an unusually large horseshoe thrombus in her left atrium and subsequent cerebrovascular complications. We also provide a review of literature, diagnostic modalities and treatment options.