Thrombus formation due to flow competition after apico-aortic conduit.

We report a case of unusual thrombus formation and describe the risk of perioperative myocardial infarction or stroke in severe aortic stenosis after apico-aortic conduit. An 86-year-old woman was admitted with aggravation of dyspnoea on exertion and chest pain. She was complicated with severe aortic stenosis and liver cirrhosis. Echocardiography demonstrated a peak pressure gradient of 50 mmHg across the aortic valve with ejection fraction of 51%. Since she had porcelain aorta and severe liver dysfunction, we selected an apico-aortic conduit under left ventricular fibrillation as treatment. Postoperative computed tomography showed a large thrombus in the descending aorta. Using strict anticoagulation therapy, the thrombus almost disappeared and thrombo-embolic events did not occur after surgery.