LAUSR

In 2017 a 79-year-old male presented 2 years after biological sutureless aortic valve replacement (IntuityTM, 25mm [Edwards Lifesciences Corporation, Irvine, CA, USA]) and mitral valve repair with worsening heart failure, severe thrombocytopenia and negative hemocultures. Prior to the first procedure in 2015, an echocardiogram showed severe enlargement of the left ventricle, with mild concentric thickening of the walls. Global systolic function of the left ventricle was mildly reduced with left ventricular ejection fraction (LVEF) of 45%. Akinesia of the basal segment of the inferior septum and hypokinesia to akinesia of basal and medial segments of the inferior wall were noticed. Left atrium was also enlarged, while the right chambers appeared of normal size. Coronarography revealed no visible disease or luminal irregularities of coronary arteries with no stenosis of two drug-eluting stents (DES) in the right coronary artery (RCA) that were inserted in 2012. Transthoracic echocardiography (TTE) on admission in 2017 showed symmetrically thickened leaflets of the IntuityTM valve (Fig. 1), maximum pressure gradient (maxPG) of 49mmHg, estimated aortic valve area (AVA) of 0.6cm2 and LVEF of 26%. Due to suspected valve thrombosis low molecular weight heparin (LMWH) treatment was initiated instead of acetylsalicylic acid [1]. After 2 weeks of therapy the leaflets appeared less thickened, with maxPG of 23mmHg and AVA of 1.1cm2 (Fig. 2) and after additional 3 months of therapy the patient was asymptomatic with normal leaflets, maxPG of 18mmHg, AVA of 2.1cm2 (Fig. 3) and LVEF of 33%.