Intraoperative Discovery of Bioprosthetic Mitral Valve Thrombus on TEE During HeartMate 3 Implantation: Implications for Anesthetic Management and Surgical Planning.
Jenny Huang, Lida Shaygan
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Case in brief
A 73-year-old woman with chemotherapy-induced cardiomyopathy, atrial fibrillation, and a bioprosthetic mitral valve was assessed for LVAD implantation. Preoperative TTE showed a mean mitral gradient of 7 mmHg but no discrete mass. Intraoperative TEE revealed a 2 cm × 1.2 cm thrombus on the prosthetic valve, prompting concurrent mitral valve replacement and HeartMate 3 implantation. Post-procedure TEE showed a mean gradient of 3 mmHg without paravalvular leak. She was discharged home in stable condition and had no thromboembolic events.
What made this case unusual
TEE detected a substantial bioprosthetic mitral valve thrombus that was not seen as a discrete mass on preoperative TTE, changing the operative plan to include valve replacement during LVAD implantation.
Diagnostic / clinical pearl
When evaluating a patient for LVAD implantation, intraoperative TEE may reveal clinically important prosthetic valve pathology not apparent as a discrete mass on preoperative TTE, with implications for surgical planning.