PMC8718547_01
(A) Echocardiogram showing a baseline trans-aortic valve mean pressure gradient of 15 mmHg 1 day after trans-aortic valve replacement (TAVR). (B) One year later, the patient developed a worsening heart failure, new onset of atrial fibrillation, and an increase of echocardiography-derived mean trans-aortic valve pressure gradient of 48 mmHg. (C) After 3-month treatment with non-vitamin K antagonist oral anti-coagulant, echocardiogram showing a mean trans-aortic valve pressure gradient of 17 mmHg.
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F1
AS with trans-aortic valve mean pressure gradient of 47 mmHg and received TAVR with a 29 mm Edwards Sapien 3 valve uneventfully in November 2019. A day after TAVR, echocardiographic-derived mean trans-aortic valve pressure gradient of the patient was 15 mmHg (Figure 1A). ECG of the patient revealed a new-onset Af and the echocardiogram disclosed an increased mean THV pressure gradient to 48 mmHg (Figure 1B), worsening mitral regurgitation (MR), and pulmonary hypertension (PH).
(A) Systolic phase, two-dimensional (2D), short-axis view showing a hypo-attenuated leaflet thickening (HALT) suggestive of thrombus involving the base of leaflets (red arrows). (B) Systolic phase, 2D, short-axis view showing the resolution of HALT after 3-month of anti-coagulant therapy. (C) Diastolic, 2-D, short-axis view showing HALT suggestive of thrombus involving the base of leaflets (red arrows). (D) Diastolic phase, 2D, short-axis view showing resolution of HALT after 3-month of anti-coagulant therapy. (E) Systolic phase, 2D, long-axis view showing HALT suggestive of thrombus involving the base of leaflets (red arrows) and reduced systolic leaflet motion. (F) Systolic phase, 2D, long-axis view showing resolution of HALT and resumed normal systolic leaflet motion after 3-month of anti-coagulant therapy. (G) Diastolic phase, 2D, long-axis view showing HALT suggestive of thrombus involving the base of leaflets (red arrows). (H) Diastolic phase, 2D, long-axis view showing the resolution of HALT after 3-month of anti-coagulant therapy. RC, right coronary cuspid; LC, left coronary cuspid; NC, non-coronary cuspid.
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F2
MDCT revealed HALT and RLM (Figures 2A,C,E,G). HALT and RLM (Figures 2B,D,F,H) 4 months after NOAC treatment. Heart failure symptoms improved gradually but Af persisted.