Severe Obstructive Pan-Leaflet Thrombosis After Transcatheter Aortic Valve Replacement

Background Bioprosthetic valve thrombosis is an uncommon but important cause of late bioprosthetic valve dysfunction after transcatheter aortic valve replacement (TAVR).Case summary An 82-year-old man with a history of TAVR presented with worsening exertional dyspnea and orthostasis after recent left atrial appendage occlusion and discontinuation of oral anticoagulation. Echocardiography demonstrated a marked rise in transvalvular gradients with restricted leaflet motion, and computed tomography confirmed severe thrombosis of all 3 bioprosthetic leaflets. Warfarin was initiated, resulting in complete symptomatic and hemodynamic resolution at 3 months.Discussion This case highlights the complexity of anticoagulant and antithrombotic management after sequential TAVR and left atrial appendage occlusion and the value of multimodality imaging in diagnosing obstructive transcatheter valve thrombosis.Take-home messages New symptoms or unexplained rise in transvalvular gradients after TAVR should prompt urgent evaluation for leaflet thrombosis. Therapeutic anticoagulation can restore leaflet motion and hemodynamics.