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Bioprosthetic Valve Thrombosis — EECC MCQ

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ModerateValvular Heart DiseaseBioprosthetic Valve ThrombosisEECC

A 68-year-old woman with a bioprosthetic aortic valve implanted 8 years ago presents with worsening dyspnoea. Echocardiography shows a mean transvalvular gradient of 35 mmHg with reduced leaflet mobility. CT shows thickened leaflets with restricted opening but no calcification. What is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Trial of anticoagulation with warfarin for 3 months and reassess

Explanation lettering: B = shown as A · C = shown as B · D = shown as C · E = shown as D · A = shown as E

Elevated gradients, reduced leaflet mobility, and thickened leaflets without calcification in a bioprosthetic valve suggest bioprosthetic valve thrombosis (BPVT). Per the 2025 ESC/EACTS VHD Guidelines, a trial of therapeutic anticoagulation (warfarin, INR 2.5-3.5) for 1-3 months is recommended. Many cases resolve with anticoagulation. Redo SAVR (A) or valve-in-valve TAVI (C) if anticoagulation fails. Fibrinolysis (D) is for haemodynamic instability. Observation (E) risks worsening obstruction.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease