Stroke Related to Transcatheter Heart Valve Thrombosis

Non-obstructive transcatheter heart valve (THV) thrombosis as a potential mechanism of stroke after transapical transcatheter aortic valve replacement (TAVR) is demonstrated by the present case report. By performing cardiac computed tomography (CT) in addition to standard transthoracic echocardiography (TTE) follow up after TAVR, it has been shown recently that non-obstructive THV thrombosis may be more common than previously anticipated. However, the clinical implications of non-obstructive THV thrombosis remain unclear. In the present patient, post-TAVR TTE and transesophageal echocardiography demonstrated normal THV function, and showed no evidence of THV thrombosis. In contrast, cardiac CT revealed findings consistent with THV thrombosis. The patient subsequently developed acute ischemic stroke that was treated with thrombolysis. Follow up cardiac CT and echocardiography

demonstrated complete THV thrombus resolution.

Video 1: Transesophageal echocardiographic shortaxis view three months after transcatheter aortic valve replacement (TAVR,) demonstrating normal cusp movements with no evidence of transcatheter heart valve (THV) thrombosis.

Video 2: Transesophageal echocardiographic short-axis view two days after stroke treated with thrombolysis demonstrating residual thrombus.

Video 3: Transesophageal echocardiographic short-axis view one month after stroke treated with thrombolysis demonstrating complete thrombus resolution.