The co-occurrence of pulmonary embolism and aortic valve thrombosis complicated by myocardial infarction as a clinical manifestation of antithrombin III deficiency: a case report.

BACKGROUND: Hypercoagulable states may lead to vascular complications in both the systemic and pulmonary systems, and these conditions may even co-occur. Thrombosis of the native aortic valve, unlike thrombotic events on prosthetic valves, is a very rare condition that may result from thrombophilia and can mimic other valvular disorders. Most significantly, it can serve as a source of further embolic events.

CASE SUMMARY: A 48-year-old man, a smoker, diagnosed in the emergency department with a small acute pulmonary embolism, was referred to the cardiology department for further treatment. After a transthoracic echocardiogram showed regional contractility dysfunction of the left ventricle, the patient underwent coronary angiography. Following the detection of acute occlusion of the posterior descending branch of the right coronary artery, an effective balloon coronary angioplasty was performed. Due to the suspicion of embolic aetiology of the myocardial infarction, the diagnostic workup was expanded to include a transoesophageal echocardiogram, which revealed a pathological structure on the aortic valve. Ultimately, thrombosis of a normally structured native aortic valve, coexisting with a slight pulmonary embolism, was diagnosed.

DISCUSSION: The low incidence of native aortic valve thrombosis as a manifestation of thrombophilia, along with its transient nature, may lead to the underestimation of this clinical issue and presents challenges in diagnostic and treatment workflows, especially in case of co-occurring pulmonary embolism.