key: cord-255719-vhjmkrlb
authors: Manghat, Nathan E.; Hamilton, Mark C.K.; Joshi, Nikhil V.; Vohra, Hunaid A.
title: Acute Post-operative Thrombosis of an Aortic Valve Prosthesis and Embolic Myocardial Infarction in a COVID-positive patient - An Unrecognised Complication
date: 2020-09-23
journal: JTCVS Tech
DOI: 10.1016/j.xjtc.2020.09.020
sha: 
doc_id: 255719
cord_uid: vhjmkrlb

A 73 year old female patient presented 14 days post aortic valve replacement (AVR) for bicuspid valve stenosis; she was diagnosed with COVID-19 infection, acute myocardial infarction, pulmonary embolism and retinal artery embolism. CT identified extensive thrombus formation on the valve struts. This demonstrated complete resolution at 11 weeks with warfarin therapy. Although venous thromboembolism is now well-documented in COVID-19 patients, this case highlights the increased risks of systemic arterial embolism following recent cardiac procedures; it also serves as a timely reminder of the consequences of COVID-19 and the radiological vigilance required in identifying AVR thrombosis on acute cardiothoracic CT. The observations made warrant careful thought with respect to perioperative anticoagulation strategy.

A 73 year old female patient presented 14 days post aortic valve replacement (AVR) for bicuspid valve stenosis; she was diagnosed with COVID-19 infection, acute myocardial infarction, pulmonary embolism and retinal artery embolism. CT identified extensive thrombus formation on the valve struts. This demonstrated complete resolution at 11 weeks with warfarin therapy.

Although venous thromboembolism is now well-documented in COVID-19 patients, this case highlights the increased risks of systemic arterial embolism following recent cardiac procedures; it also serves as a timely reminder of the consequences of COVID-19 and the radiological vigilance required in identifying AVR thrombosis on acute cardiothoracic CT.

The observations made warrant careful thought with respect to perioperative anticoagulation strategy.

J o u r n a l P r e -p r o o f Differential diagnosis was myocarditis or myocardial infarction (MI); stress perfusion cardiac 24 magnetic resonance imaging (MRI) demonstrated typical extensive acute LAD territory MI 25 with microvascular obstruction but no ischaemia, tamponade or myocarditis. Susceptibility 26 metallic artefact ( Figure 1A) inhibited AVR assessment.

Cardiac radiologist CT review also identified extensive low attenuation, lobulated and 28 fragmented soft tissue thrombus formation seen in the vicinity of and applied to the valve 29 prosthesis frame (but not the leaflets) and in close proximity to the left main stem ostium 30 ( Figure 1B and C) , evidence of a small acute apical MI (Figure 1D) , probable evolving peri- 

COVID-19 coagulopathy: an evolving story

coronaViral Imaging and Diagnostics (COVID)

COVID-19 and its implications for thrombosis and anticoagulation

iv Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19

v Cardiac arrest due to acute massive aortic root thrombosis after pericardial bioprosthetic aortic valve replacement