Persistently Stuck Mitral Mechanical Prosthesis Rescued Successfully With Deflectable Electrophysiology Catheter.

BACKGROUND

Mechanical mitral valve thrombosis is life threatening and traditionally managed with surgery or thrombolysis, both carrying significant risks. In patients with contraindications, alternative interventions are seldom described in guidelines.

CASE SUMMARY: A 38-year-old woman with a recently replaced 27-mm mechanical mitral valve presented in cardiogenic shock due to valve leaflet immobility. With a prohibitive surgical risk and elevated international normalized ratio (5.0) precluding thrombolysis, a percutaneous transcatheter mechanical thrombectomy with improvised cerebral protection was performed. Leaflet mobility was restored using sequential balloon dilation and a deflectable electrophysiology catheter. The procedure resulted in hemodynamic stabilization and complete neurologic recovery.

WHY BEYOND GUIDELINES: Current European Society of Cardiology/American College of Cardiology guidelines do not address transcatheter thrombectomy in obstructive mechanical valve thrombosis. This case underscores its potential in selected high-risk scenarios.

DISCUSSION: The novel use of an electrophysiology catheter for leaflet mobilization and nonconventional cerebral protection strategies can enable successful outcomes when conventional therapies are contraindicated.

TAKE-HOME MESSAGE: Transcatheter thrombectomy may be a viable salvage option in select patients with obstructive mechanical mitral valve thrombosis.