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\begin{document}

\title{Acute valve malfunction with thrombosed bioprosthetic valve after
surgical aortic valve replacement}



\author[1]{Hiroki Moriuchi}%
\author[1]{Masaaki Koide}%
\author[1]{Yoshifumi Kunii}%
\author[1]{Takuya Maeda}%
\author[1]{Risa Shimbori}%
\affil[1]{Seirei Hamamatsu Hospital}%


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  \date{May 18, 2024}


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Title: Acute valve malfunction with thrombosed bioprosthetic valve after
surgical aortic valve replacement

Author name: Hiroki Moriuchi, Masaaki Koide, Yoshifumi Kunii, Takuya
Maeda, Risa Shimbori

Affiliations: SeireiHamamatsu Hospotal, Department of cardiovascular
surgery

Key words: thrombus, bioprosthetic aortic valve

Corresponding author's address: 2-12-12, Sumiyoshi, Nakaku, Hamamatsu,
Shizuoka, Japan

Email: \emph{porimori22@gmail.com}

AUTHOR CONTRIBUTIONS

Masaaki Koide and Takuya Maeda involved in review and editing.

ACKNOWLEDGEMENTS

I appreciate Mr. Andrew for reviewing manuscript and Yuki Moriuchi for
total support.

FUNDING INFORMATION

None

CONFLICT OF INTEREST STATEMENT

The authors report no conflict of interest.

DATA AVAILABILITY STATEMENT

None

CONSENT STATEMENT

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

CASE PRESENTATION

A 74-year-old man with chest pain was diagnosed with Stanford A acute
aortic dissection and severe aortic regurgitation. Aortic valve
replacement with a 21mm INSPIRIS (Edwards Lifesciences, Irvine, CA, USA)
and ascending aortic replacement with 26mm J Graft (Japan Lifeline,
Tokyo) was performed. Anticoagulation therapy using heparin and warfarin
was started immediately. Postoperative Computed tomography(CT) revealed
thrombus formation to all leaflets of the implanted valve(Figure1) and
echocardiography revealed restricted leaflet motion, so surgical
thrombectomy was performed. Abundant fresh thrombi adhered to all
leaflets of the bioprosthetic valve, and those thrombi were carefully
removed (Figure2). No damage or macroscopic degeneration on the leaflets
were seen, so the implanted valve was preserved. We initiated
argatoroban for 1 week, followed by aspirin and warfarin and
postoperative CT showed no sign of thrombus. (Figure 3).

We previously reported leaflet and coronary stent thrombosis after
TAVR\textsuperscript{2}, but acute bioprosthetic valve thrombosis after
SAVR is extremely rare.\textsuperscript{1}

Reference

1. Cahill TJ, Khalique OK, Geourge Im et al. Valve thrombosis after
transcatheter and surgical aortic valve replacement: Incidence and
outcomes. J Thorac Cardiovasc Surg.~2022 Apr;163(4):1309-1315.

2. Satoshi O, Masaaki K, Yoshifumi K, et al. Leaflet and coronary stent
thrombosis after transcatheter aortic valve implantation treated by
aortic valve replacement. Eur Heart J Cardiovasc Imaging. 2020 Mar
1;21(3):347

Figure legends

Figure1: Computed tomography(CT) shows thrombi in all leaflets

Figure2: All thrombi were removed completely

Figure3: Postoperative CT shows no thrombus in bioprosthetic aortic
valve

Key Clinical Message

Acute valve thrombosis after bioprosthetic aortic valve replacement even
under appropriate anticoagulation therapy is extremely rare. Cardiac CT
is a powerful imaging tool to detect valve thrombosis after both TAVR
and SAVR.\selectlanguage{english}
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