A mass obstructing mechanical prosthetic heart valve: thrombus or pannus?

Description

Mechanical prosthetic valve obstruction carries a significant morbidity and mortality, if not treated urgently. Most notable causes of an acquired obstruction include thrombosis and pannus formation.1 It is critically important to exclude isolated pannus, since thrombolysis is an effective and rapid treatment option in case of a thrombus, while it is contraindicated in pannus. Published guidelines provide no diagnostic strategy to differentiate them.2 Transesophageal echocardiogram (TEE) is indispensable for assessing the leaflet motion and the nature and extent of the obstructing mass. However, in resource-poor settings, where TEE is not always available, therapy is based on transthoracic echocardiography and fluoroscopic findings.

A 50-year-old woman presented with complaints of worsening dyspnoea associated with orthopnoea for 3 days. She had undergone a mitral valve replacement with a mechanical bi-leaflet prosthesis 6 months prior for severe rheumatic mitral regurgitation, following which she was asymptomatic. Examination revealed blood...

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