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Outcomes of Native Aortic Valve Thrombosis
Quick Takes
- In a literature review, 74 cases of native aortic valve thrombosis were identified.
- The most common presentations were in the settings of MI, asymptomatic presentation, limb ischemia, or stroke; and the most common underlying etiologies were hypercoagulable state, idiopathic, or LVAD.
- In-hospital clinical deterioration after presentation including recurrent embolism occurred in ~38% of cases, and in-hospital mortality rate was ~20%.
Study Questions:
What are the characteristics, presentations, underlying etiologies, and outcomes of native aortic valve thrombosis?
Methods:
Using the key words “aortic valve thrombosis” or “aortic valve thrombus,” published medical literature was systematically reviewed for studies, case reports, abstracts, presentations, posters, letters to the editor, and brief communications about native aortic valve thrombosis. Data were extracted and a meta-analysis was performed.
Results:
The search and screening process yielded 74 cases of native aortic valve thrombosis. In these, the diagnosis was confirmed by inspection during thrombectomy and pathology examination in 48 cases and by autopsy in four cases; of the remaining 22 cases, the diagnosis was based on the resolution of the thrombus following antithrombotic therapy in eight cases, or based only on clinical and imaging findings in 14 cases. Reported cases increased from two in the 1980s to 13 in the 1990s, 22 in the 2000s, and 37 from 2010 to current. The most common presentation was myocardial infarction (MI) in 36%; followed by asymptomatic presentation (23%), limb ischemia (12%), stroke (11%), and other presentations. The most common underlying etiology was hypercoagulable state in 30%; followed by idiopathic in 19%, left ventricular assist device (LVAD) in 18%, and other etiologies. Diagnostic testing accuracy was 100% for aortic root angiography and transesophageal echocardiography, 59% for transthoracic echocardiography, and 29% for coronary angiography. In-hospital clinical deterioration after presentation including recurrent embolism occurred in approximately 38%, and in-hospital mortality rate was approximately 20%.
Conclusions:
The authors concluded that: 1) native aortic valve thrombosis is clinically relevant, especially in patients presenting with embolic events; and 2) awareness about native aortic valve or root thrombosis and its underlying etiologies, diagnostic workup, and management is essential, because the condition can be associated with poor outcomes.
Perspective:
This literature review found a total of 74 reported cases of native aortic valve thrombosis, with an increasing frequency over time presumably related to improved diagnostic testing. Without knowing its true incidence, it is hard to think of this as a common clinical problem. The relative role of native aortic valve thrombosis as a cause of clinical events such as acute MI, limb ischemia, or stroke presumably is small; but outcomes appear to be poor.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Mechanical Circulatory Support, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Coronary Angiography, Diagnostic Imaging, Echocardiography, Echocardiography, Transesophageal, Embolism, Fibrinolytic Agents, Heart-Assist Devices, Heart Valve Diseases, Hospital Mortality, Ischemia, Myocardial Infarction, Stroke, Thrombectomy, Thrombosis, Vascular Diseases
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