Acute Prosthetic Mechanical Mitral Valve Thrombosis Following Open Cholecystectomy

Abstract

A 61-year-old woman was referred for chest discomfort 7 days after successful open cholecystectomy. She has had a prosthetic mechanical mitral valve for 10 years and been on warfarin medication since then. Her preoperative cardiac work-up showed good mechanical valve function with optimal prothrombin time international normalized ratio levels. However, anticoagulation was inadequate during the immediate postoperative period, and subsequent echocardiograms revealed a newly developed thrombus with one leaflet fixation. Having an acute thrombus with New York Heart Association functional class I-II and a strong reluctance to redo open heart surgery, fibrinolytic therapy was performed. Acute bleeding from a pseudoaneurysm of the right hepatic artery interrupted the intravenous alteplase infusion and required emergency coil embolization. Ultimately, the mechanical click sound resumed, and a subsequent echocardiogram revealed successful resolution of the acute thrombus and restored mechanical mitral valve prosthesis function.