Bioprosthetic Aortic Valve Thrombosis Presenting as Recurrent Inferior Wall STEMI.

BACKGROUND

Prosthetic aortic valve thrombosis is an extremely rare cause of ST-segment elevation myocardial infarction (STEMI). This case highlights the diagnostic challenge of this clinical entity.

CASE SUMMARY: A 71-year-old man with bioprosthetic aortic and mitral valve replacement 15 years prior presented with recurrent inferior wall STEMI. Coronary angiography showed no significant stenosis, consistent with myocardial infarction with nonobstructive coronary arteries (MINOCA). Transesophageal echocardiogram revealed a 2-cm mobile thrombus on the right coronary cusp of the prosthetic aortic valve, intermittently occluding the right coronary artery ostium.

DISCUSSION: Bioprosthetic valve thrombosis typically occurs early postimplantation; this case is notable for its 15-year latency. It underscores the need to consider valve thrombosis in patients with bioprosthetic valves presenting with embolic phenomena or MINOCA, even long after surgery.

TAKE-HOME MESSAGES: Clinicians should maintain a high suspicion for prosthetic valve thrombosis as a cause of MINOCA. Early diagnosis using comprehensive imaging, particularly transesophageal echocardiography, is critical to prevent complications.