Bioprosthetic Valve Thrombosis and Obstruction Secondary to COVID-19

Abstract

Patients with COVID-19 may present a hypercoagulable state, with an important impact on morbidity and mortality. Because of this situation pulmonary embolism is a frequent complication during the course of infection. We present the case of a patient recently discharged, after admission with confirmed COVID-19, who developed a pulmonary embolism and thrombosis of a biological mitral valve prosthesis, producing valve obstruction and stenosis. After 15 days of anticoagulant treatment, resolution of the thrombus and normalization of prosthetic valve function was observed. This case supports current recommendations of administering full-dose anticoagulation therapy to COVID-19 patients with biological heart valve prosthesis, even after the acute phase of infection.

Comprehensive collection of COVID-19 related prosthetic valve failure: a systematic review

“…The eight COVID-19-related PVT cases documented in this paper include valve type (mitral versus aortic) and prosthesis type (bioprosthetic versus mechanical). Of these cases, five involved prostheses in the mitral valve position, three of which were mechanical [ 5 – 7 ] and two were bioprosthetic [ 8 , 9 ]; three of the eight cases involved aortic valve prostheses, one being mechanical [ 10 ] and two being surgical bioprosthetic valves [ 11 , 12 ] (Table 1 ). Seven of eight patients had symptoms of dyspnea or hypoxia [ 5 – 9 , 11 , 12 ].…”

“…All patients in these cases tested positive for COVID-19 within two months prior to the PVT diagnosis; three PVT cases were diagnosed during hospitalization with COVID-19 [ 7 , 10 , 12 ]. Additionally, five cases occurred greater than three years after the most recent valve replacement [ 5 – 8 , 10 ], and the other three bioprosthetic valves failed within eight months of valve replacement [ 9 , 11 , 12 ]. One case, described by Vinnakota et al, documented a recurrent case of PVT: 12 months after initial mitral and aortic valve replacements, the patient underwent transcatheter mitral valve-in-valve implantation for suspected early mitral bioprosthetic stenosis secondary to PVT, and seven months afterwards was diagnosed with COVID-19, presenting with a second PVT within the next month.…”

“…Of the six cases that included, inflammatory markers were noted to be increased when included in the case reports – including elevated D-dimer [ 5 , 7 , 8 , 10 – 12 ], ranging from 372 ng/mL [ 10 ] to 6893 ng/mL [ 5 ].…”

“…Five of eight cases described severe COVID-19 infection including hospitalization with associated respiratory distress and associated abnormal lung findings seen on imaging [ 5 – 8 , 11 ]; one case further developed measured pulmonary hypertension and respiratory failure [ 5 ], one developed pulmonary edema subsequent to supraventricular tachycardia [ 7 ] and one developed pulmonary congestion with pleural effusion [ 8 ]. In addition to PVT, two of the eight cases documented other thrombotic events also presumed to be associated with COVID-19 infection: Manghat et al diagnosed pulmonary embolism, embolic myocardial infarction, and symptoms of retinal artery embolism, and Llopis Gisbert et al also included pulmonary embolism.…”

Management of Obstructive Prosthetic Heart Valve Thrombosis: Thrombolytic Therapy or Anticoagulation?

“…We have recently read with great interest the article by Gisbert et al entitled ‘‘Bioprosthetic Valve Thrombosis and Obstruction Secondary to COVID-19’’ [ 1 ]. We appreciate the authors for their case reports describing the successful management of prosthetic valve thrombosis (PVT) secondary to COVID-19.…”