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Taira S, Nishihira M, Oba K, Narayama K, Yamauchi A. Aortic valve thrombosis in nephrotic syndrome: a case report. J Nephrol 2024:10.1007/s40620-024-02026-2. [PMID: 39078469 DOI: 10.1007/s40620-024-02026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/30/2024] [Indexed: 07/31/2024]
Abstract
We report a rare case of aortic valve thrombosis in a 55-year-old man. He had reduced urine output and generalized edema four days before admission. He felt sick and had chest pain on the day of admission. Severe hypoalbuminemia and massive proteinuria were present, and a diagnosis of nephrotic syndrome was made. An electrocardiogram showed findings suspicious for acute myocardial infarction, and emergency catheterization was performed. However, no coronary artery stenosis or occlusion was found at that time. A subsequent contrast-enhanced CT scan and transesophageal echocardiography revealed a thrombus in the aortic valve. The thrombus nearly occluded the left coronary artery. Emergency surgery was performed to remove the thrombus. His postoperative course was stable, but nephrotic syndrome persisted. A renal biopsy diagnosed minimal change disease. Treatment with 50 mg/day of prednisolone induced remission, and he was discharged on day 43. There were no aortic valve abnormalities. Nephrotic syndrome was considered the main contributor to thrombus formation. Aortic valve thrombosis associated with nephrotic syndrome is a very rare but potentially fatal condition that requires attention.
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Affiliation(s)
- Shogo Taira
- Department of Nephrology, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan.
| | - Morikuni Nishihira
- Department of Nephrology, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan
| | - Kageyuki Oba
- Department of Cardiology, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan
| | - Kohei Narayama
- Department of Cardiovascular Surgery, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan
| | - Akihiko Yamauchi
- Department of Cardiovascular Surgery, Yuuai Medical Center, 50-5 Yone, Tomigushuku City, Okinawa, 901-0224, Japan
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2
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Kladou E, Kochiadakis G, Hamilos M. Unexpected finding on imaging: an aortic valve mass. Heart 2024; 110:939-970. [PMID: 38918028 DOI: 10.1136/heartjnl-2024-324148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Affiliation(s)
- Eleni Kladou
- University General Hospital of Heraklion Medical Service, Heraklion, Greece
| | | | - Michalis Hamilos
- Cardiology, University General Hospital of Heraklion Medical Service, Heraklion, Crete, Greece
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3
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Zivkovic I, Milacic P, Tabakovic Z, Micovic S, Milicic M. Fatal hyperacute left main thrombosis after aortic root surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:222-224. [PMID: 38933317 PMCID: PMC11197413 DOI: 10.5606/tgkdc.dergisi.2024.24507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 09/17/2023] [Indexed: 06/28/2024]
Abstract
Acute aortic root thrombosis is a potentially lethal condition due to the possibility of thrombosis into the ascending aorta branches, resulting in various clinical manifestations. A 29-year-old male patient was admitted to our center with hyperacute left main thrombosis after elective Bentall procedure. Due to massive left ventricular infarction, the patient was supported by extracorporeal membrane oxygenation, but without success to recovery. The patient's blood analyses revealed a high level of the Factor VIII. In conclusion, Factor VIII levels in the blood are elevated by genetic abnormalities, infectious diseases such as severe acute respiratory syndrome-coronavirus 2 infection, and vascular inflammation. This pathological condition may be a reason for hyperacute thrombosis.
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Affiliation(s)
- Igor Zivkovic
- Department of Cardiac Surgery, Cardiovascular Institute Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Milacic
- Department of Cardiac Surgery, Cardiovascular Institute Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zoran Tabakovic
- Department of Cardiac Surgery, Cardiovascular Institute Dedinje, Belgrade, Serbia
| | - Slobodan Micovic
- Department of Cardiac Surgery, Cardiovascular Institute Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav Milicic
- Department of Cardiac Surgery, Cardiovascular Institute Dedinje, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Motiduki N, Ushioda R, Yuzawa S, Miyatani K, Isa H, Setogawa Y, Ishidou K, Narita M, Suzuki F, Hirofuji A, Okubo R, Kunioka S, Tsutsui M, Ishikawa N, Hiroyuki K. A case of non-bacterial thrombotic endocarditis on the aortic valve following coronary angiography. J Surg Case Rep 2024; 2024:rjae212. [PMID: 38572290 PMCID: PMC10989293 DOI: 10.1093/jscr/rjae212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Nonbacterial thrombotic endocarditis (NBTE) on the aortic valve involves fibrin and platelet aggregate formation, potentially leading to embolic events. We present a case of NBTE on the aortic valve following coronary angiography (CAG) in a 54-year-old man with multiple comorbidities. Surgical thrombectomy was performed owing to acute cerebral infarcts. This case highlights the significance of considering that mechanical trauma from catheterization during CAG can trigger thrombus formation.
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Affiliation(s)
- Nobuhiro Motiduki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Ryohei Ushioda
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Midorigaoka 1-1-1, Asahikawa 078-8510, Japan
| | - Kazuki Miyatani
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Hideki Isa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Yuki Setogawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Kohei Ishidou
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Masahiko Narita
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Fumitaka Suzuki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Ryo Okubo
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Masahiro Tsutsui
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
| | - Kamiya Hiroyuki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan
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Somani S, Makhija N, Francis J, Devagourou V. Noncoronary Cusp Thrombus on Transesophageal Echocardiography Altering the Surgical Approach. J Cardiothorac Vasc Anesth 2024; 38:855-857. [PMID: 38105127 DOI: 10.1053/j.jvca.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Shruti Somani
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Jijo Francis
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Alamri F, Eltayeb A, Hamad A, Alamri S, Alamri S, Kaidali W, Tashkandi L, Arbili L, Pergola V, Al Sergani H. A native mitral valve mass beyond imagination. Monaldi Arch Chest Dis 2023; 94. [PMID: 37551101 DOI: 10.4081/monaldi.2023.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023] Open
Abstract
The authors report a case of a patient with a history of immunoglobulin A nephropathy who, during the admission for pneumonia, had an incidental finding of a huge mitral valve (MV) mass on transthoracic echocardiography. The differential diagnosis was challenging because the clinical scenario raised the suspicion of possible infective endocarditis, and the imaging features were suggestive of a myxoma or vegetation. The patient underwent urgent excision of the mass with MV replacement due to the high risk of embolism. Intraoperative findings were consistent with clots or vegetation. The pathology result of the thrombus was beyond our imagination, and to the best of our knowledge, only one case has been reported. Awareness about native MV thrombosis and its etiologic factors, work-up, and management is key for better medical and surgical management planning because this condition is extremely rare and challenging in the clinical and imaging arenas.
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Affiliation(s)
- Faisal Alamri
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Abdalla Eltayeb
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
| | - Alaa Hamad
- College of Medicine, Alfaisal University, Riyadh.
| | - Soaad Alamri
- College of Medicine, Alfaisal University, Riyadh.
| | - Sultan Alamri
- King Saud bin Abdulaziz University for Health Sciences, Riyadh.
| | | | | | - Lana Arbili
- College of Medicine, Alfaisal University, Riyadh.
| | - Valeria Pergola
- Department of Cardio-Thoraco- Vascular Sciences and Public Health, University of Padua.
| | - Hani Al Sergani
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh.
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Papillary fibroelastoma causing severe aortic stenosis. J Cardiol Cases 2023; 27:120-123. [PMID: 36910032 PMCID: PMC9995653 DOI: 10.1016/j.jccase.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Herein, we present a rare case of papillary fibroelastoma of the aortic valve, which caused severe aortic stenosis. The papillary fibroelastoma developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure. The patient underwent an urgent surgical treatment, which resulted in a successful outcome. To the best of our knowledge, this is the first case of papillary fibroelastoma in which aortic stenosis was so severe as to cause congestive heart failure. Learning objective Papillary fibroelastoma (PFE) is the most commonly observed primary cardiac tumor in adults that commonly involves left heart chambers. While PFEs often cause embolisms, they rarely cause valvular dysfunction. In a case presented herein, a PFE developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure.
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Kim H, Kim HR, Kang MG, Kim K, Koh JS, Park JR, Hwang SJ, Hwang JY. Native Aortic Valve Thrombus Complicating Intermittent Occlusion of a Left Main Coronary Artery. Intern Med 2022; 61:3687-3691. [PMID: 35569992 PMCID: PMC9841114 DOI: 10.2169/internalmedicine.9652-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Intermittent left main coronary artery ostium obstruction (LMOO) caused by native aortic valve thrombus (NAVT) is an extremely rare condition. It may therefore be challenging to identify the cause using only coronary angiography, even though the clinical presentation and electrocardiography (ECG) strongly suggest myocardial infarction. We herein report a 53-year-old man with NAVT complicating intermittent occlusion of left main disease in preexisting coronary artery stenosis.
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Affiliation(s)
- Hangyul Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Hye-Ree Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Kyehwan Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Jeong-Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Seok-Jae Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Republic of Korea
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9
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Chavda Y, Givergis R. Shortness of breath with an aortic valve mass. VISUAL JOURNAL OF EMERGENCY MEDICINE 2022; 28:101425. [PMID: 35756581 PMCID: PMC9212960 DOI: 10.1016/j.visj.2022.101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Yash Chavda
- Nassau University Medical Center, East Meadow, NY, USA
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10
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Gómez JLZ, Gómez AG. Aortic Valve Thrombosis: Be Prepared for the Unusual. J Am Coll Cardiol 2021; 78:825-826. [PMID: 34412816 DOI: 10.1016/j.jacc.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
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