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Mechanical prosthetic valve thrombosis — ABIM Board MCQ

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HardCardiovascularMechanical prosthetic valve thrombosisABIM Board

A 69-year-old woman with a mechanical mitral valve presents with dyspnea. INR is 1.5 after missed warfarin doses. Exam shows muffled prosthetic clicks. Transthoracic echocardiography shows elevated transvalvular gradient, but leaflet motion is not well seen. Which of the following is the most appropriate diagnostic study?

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Correct answer: B — Transesophageal echocardiography or cinefluoroscopy for prosthetic valve motion

Suspected mechanical valve thrombosis requires urgent assessment of thrombus burden and leaflet motion. TEE and cinefluoroscopy are appropriate complementary studies after abnormal transthoracic gradients.

Reference: 2020 ACC/AHA Valvular Heart Disease Guideline