Author/Authors :
Panduranga, Prashanth Royal Hospital - Department of Cardiology, Oman , Alam, Faisal Royal Hospital - Department of Vascular Surgery, Oman , Ratnam, Laxmi Royal Hospital - Department of Radiology, Oman , Al-Zadjali, Matllooba Royal Hospital - Department of Medicine, Oman , Al-Deeb, Mohammed Royal Hospital - Department of Cardiology, Oman
Abstract :
A 45-year-old woman presented with refractory pulmonary oedema secondary to a massive thrombosis of a St. Jude mechanical mitral prosthetic valve. She was noncompliant with warfarin and had suffered embolic stroke 3 years earlier, from which she had recovered. She was in sinus rhythm with absent valve clicks on auscultation. A transthoracic echocardiogram revealed a high transmitral peak gradient of 34 mmHg and a mean gradient of 27 mmHg with an ejection fraction of 55% [Figure 1A]. The international normalised ratio (INR) was 1.29. An urgent transesophageal echocardiogram (TEE) demonstrated a large (6 cm2) left atrial thrombus attached to the mechanical valve at the discs which were stuck in a closed position
