Mitral Valve Thrombosis 5 Years After Successfully Treated Prosthetic Endocarditis

A 63-year-old man came to our emergency department with a 2-week history of progressive exercise dyspnea and diastolic murmur of volume 2/6 with the punctum maximum at Erb’s point. Six years earlier the patient had received a biological mitral valve replacement due to severe mitral valve insufficiency. A year later, infectious endocarditis of the biological prosthesis was diagnosed and treated successfully with antibiotics. Our initial endocardiography examination showed severe mitral valve stenosis. All the cusps of the bioprosthesis appeared thickened, with marked subvalvular thrombosis. The patient was hemodynamically stable, so after interdisciplinary discussion in the cardiac team we decided against revision surgery and started complete anticoagulation with Marcumar (target INR: 2.5–3.5). Regression of the thrombus was observed. Because the INR was unstable we changed the anticoagulation regimen to apixaban 5 mg twice daily. At the final follow-up visit after 3 months the valve appeared normal. We told the patient that we recommended long-term anticoagulation with apixaban. The precise etiology of this case of valvular thrombosis remains speculative, one possibility being postendocarditic microtrauma.

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Dr. med. Stephanie Löbig, Patricia Hägele, Prof. Dr. med. Peter Seizer, Ostalb-Klinikum Aalen, Innere Medizin II, Kardiologie, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Löbig S, Hägele P, Seizer P: Mitral valve thrombosis 5 years after successfully treated prosthetic endocarditis. Dtsch Arztebl Int 2023; 120: 691. DOI: 10.3238/arztebl.m2023.0101