Nonbacterial thrombotic endocarditis of a bioprosthetic valve: Questions to ponder before replacement of the valve

Abstract

Nonbacterial thrombotic endocarditis (NBTE) of bioprosthetic valves is extremely rare. We report a 67‐year‐old lady with early bioprosthetic “failure” that at reoperation was proven to be NBTE. The choice of a prosthesis in this condition may have implications for patients’ late clinical course.

Nonbacterial Thrombotic Endocarditis of Bioprosthetic Aortic Valve Presenting as Cardioembolic Stroke in a Patient without Predisposing Systemic Disease

“…Unfortunately, there is insufficient data to address this question at present due to the rarity of NBTE in patients with bioprosthetic heart valves. We agree with Ram et al's assertion that patients with bioprosthetic heart valves and risk factors for NBTE be anticoagulated [ 7 ].…”

“…One patient had bilateral renal infarcts and died following pulseless electrical activity arrest [ 6 ]. The other did not have any evidence of embolic phenomena and recovered following redo bioprosthetic aortic valve replacement [ 7 ].…”

“…Additional complexity arises in cases where, similar to our patient, patients do not have modifiable risk factors for NBTE. Ram et al raise the question of whether there would exist any benefit in choosing a mechanical valve instead of a redo bioprosthetic valve in this cohort of patients [ 7 ]. Unfortunately, there is insufficient data to address this question at present due to the rarity of NBTE in patients with bioprosthetic heart valves.…”

“…NBTE involving bioprosthetic valves is exceedingly rare. Only two cases involving patients without predisposing underlying systemic disease have previously been reported [ 6 , 7 ].…”