Case report: Mechanical mitral prosthetic valve thrombosis in the context of COVID-19 despite effective anticoagulation

Abstract

Background The SARS-CoV2 virus has been an emerging virus since December 2019 and is the cause of a global pandemic whose clinical manifestations extend far beyond respiratory disease. Case summary A patient with severe COVID 19 respiratory infection, carrying a mechanical mitral valve and under anticoagulation, was admitted in our cardiology department because of a new atrial fibrillation, which turned out to be related to thrombosis of the mitral mechanical valve. Conclusion The pro-coagulant effect of the SARS-CoV2 virus does not spare patients at risk of thrombosis, even under effective anticoagulation. In patients with mechanical valves under vitamin K antagonist treatment, there is a high risk of thrombus formation. The treatment is based on thrombolysis by therapeutic anticoagulation, fibrinolysis or surgery depending on the size, composition of thrombus and clinical manifestation.

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 ].…”

“…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 ]. Al Helali et al presented a patient with a mechanical aortic valve prosthesis presenting with a change in character of cardiac auscultation and generalized fatigue [ 10 ].…”

“…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.…”

Screening the Potential Biomarkers of COVID-19-Related Thrombosis Through Bioinformatics Analysis

“…Studies have also suggested that elevated levels of neutrophil extracellular traps are closely related to thrombotic events ( Zuo et al, 2021 ), but their overall role in COVID-19-related thrombosis remains unclear ( Bonaventura et al, 2021 ). At present, most reports on thrombosis in patients with COVID-19 are case reports ( Achim et al, 2022 ; Bleiziffer et al, 2022 ; Jeckelmann et al, 2022 ; Russell et al, 2022 ; Takasu et al, 2022 ) and some observational studies ( Maier et al, 2020 ). Even after strict ethical review, only a small number of large studies have confirmed the relationship between the use of anticoagulants and the survival rate of COVID-19 ( Lawler et al, 2021 ).…”