Background: Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Mechanical prosthetic valve thrombosis is a life-threatening complication necessitating immediate intervention. The presenting signs and symptoms of this illness are somewhat variable, and often complicated to recognize, especially in patients with COVID-19.

Aims: We present a case of a 63-year-old woman with a clinical presentation of heart failure symptoms due to mechanical mitral valve thrombosis overlapping with mild COVID-19 pneumonia.

Methods: Clinical case presentation.

Results: The patient presented to the emergency unit with marked dyspnea, asthenia, oliguria, hypotension, oxygen desaturation (83%), and right ventricular dysfunction. The primary diagnosis  was made based on chest X-ray – bilateral pulmonary infiltration and tests suggestive of SARS-COV2 viral infection, including increased values of d-dimer- 5.43. After receiving the negative result of the PCR test at COVID-19, the patient was transferred to the cardiology department with suspicion of PE. EchoCG examinations establishedmitral  mechanical valve dysfunction  with a gradient of 56 mm Hg. Given the patient’s critical condition we used alteplase and UFH, obtaining symptomatic relief and hemodynamic stability. We identified an extremely elevated D-dimer (>10 mcg/mL), and computed tomography pulmonary angiography (CTPA) revealed an unexpected low thrombus burden. Research into the cause of thrombosis found low INR values (1,37) despite regular use of unchanged dose of warfarin, and immunological tests found anti-SARS-VOC 2 antibodies.

Conclusions: This case raises awareness to the catastrophic thrombosis of mechanical valve, presenting in an late phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/mechanical-prosthetic-valve-thrombosis-in-covid-19-infection-case-report/