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 acetylsali-cylic acid since the surgery. On 28th day of postoperative period an ischemic
stroke occurred. In transoesopha-gal echocardiography we have discovered non-obstructive
thrombosis of the artificial mitral annulus and a leakiness in left atrial appendage (LAA) closure.
There was rapid outflow through the gap in closure 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 disrupted LAA closure.