Improving the Function of Thrombosed Aortic Bioprosthetic Valves through Anticoagulation

Improving the Function of Thrombosed Aortic Bioprosthetic Valves through Anticoagulation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Improving the Function of Thrombosed Aortic Bioprosthetic Valves through Anticoagulation Masahiro Inagaki, Satoki Ozoe, Yutaka Koyama, Shinji Tomita This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3998703/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Hypoattenuated leaflet thickening (HALT), a potential aftereffect of both surgical and transcatheter bioprosthetic aortic valve procedures, may affect valve performance and clinical outcomes. Here, we describe an elderly patient who, underwent surgical aortic valve replacement with a bioprosthetic valve for aortic stenosis (SAVR), was hospitalized due to heart failure, and complained of worsening dyspnea. The patient’s echocardiography showed an elevated pressure gradient in the aortic valve, while CT revealed HALT on the right coronary cusp of the aortic bioprosthetic valve. Following the diagnosis of a thrombosed bioprosthetic valve, anticoagulation therapy with Coumadin was initiated. The patient's dyspnea symptoms improved, and echocardiography revealed a decreased pressure gradient in the aortic valve three months after starting anticoagulation therapy. This case highlights the significance of considering anticoagulation as the primary treatment option for patients with HALT of a bioprosthetic aortic valve. HALT thrombosed valve anticoagulation Figures Figure 1 Background The hypoattenuated leaflet thickening (HALT) phenomenon on computed tomography (CT), which reduces leaflet motion in both surgical and transcatheter bioprosthetic aortic valves, was first reported by Makkar and colleagues1. Case presentation The patient's condition with HALT may be considered subclinical. Fourteen months ago, a 79-year-old woman underwent surgical aortic valve replacement with a 19 mm Epic Supra bioprosthetic valve (Abbott Vascular, California) for aortic stenosis. One month prior, the patient was hospitalized due to heart failure, and complained of worsening dyspnea. Echocardiography revealed an elevated pressure gradient in the aortic valve (Fig._1A), while CT revealed HALT on the right coronary cusp of the aortic bioprosthetic valve (Fig._1B diastole/systole). Following the diagnosis of a thrombosed bioprosthetic valve, anticoagulation therapy with Coumadin was initiated. The patient's dyspnea symptoms improved, and echocardiography revealed a decreased pressure gradient in the aortic valve three months after starting anticoagulation therapy (Fig._1-C). CT revealed that the HALT disappeared six months after anticoagulation therapy was initiated (Fig. 1D, diastole/systole). Discussion and Conclusions Brown ML et al. reported that the incidence of thrombosed valves in porcine aortic bioprostheses was 0.55%, which was greater than that of stented pericardial valves 2 . Patients with heart failure who have a thrombosed bioprosthetic valve may require a redo aortic valve replacement. However, initiating anticoagulation therapy can potentially improve not only patients’symptoms but also their laboratory data. This includes reducing the pressure gradient of the aortic valve or eliminating HALT on CT scan, as in this case. Therefore, anticoagulation therapy should be the primary treatment option for patients with HALT of a bioprosthetic aortic valve. List Of Abbreviations The hypoattenuated leaflet thickening (HALT) computed tomography (CT) Declarations Ethics approval and consent to participate ：Not applicable Consent for publication ：informed consent for publication was obtained Availability of data and materials ：Not applicable Competing interests ：The authors declare that they have no competing interests Funding ：None Author Contribution Y.K. and M.I wrote the main manuscript text and prepared figures. All authors reviewed the manuscript." Acknowledgements ：Not applicable References Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, De Backer O, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015–24. Brown ML, Park SJ, Sundt TM, Schaff HV. Early thrombosis risk in patients with biologic valves in the aortic position. J Thorac Cardiovasc Surg. 2012;144(1):108–11. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3998703","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":276775731,"identity":"7775370a-3242-4ef8-8eff-7cb8d772a785","order_by":0,"name":"Masahiro Inagaki","email":"","orcid":"","institution":"Gifu Heart Center","correspondingAuthor":false,"prefix":"","firstName":"Masahiro","middleName":"","lastName":"Inagaki","suffix":""},{"id":276775732,"identity":"858823c7-e0ae-4ab2-ac77-3ff9544837ee","order_by":1,"name":"Satoki Ozoe","email":"","orcid":"","institution":"Gifu Heart Center","correspondingAuthor":false,"prefix":"","firstName":"Satoki","middleName":"","lastName":"Ozoe","suffix":""},{"id":276775733,"identity":"4fb87bc5-1683-49eb-8129-8e75438837fd","order_by":2,"name":"Yutaka Koyama","email":"data:image/png;base64,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","orcid":"","institution":"Gifu Heart Center","correspondingAuthor":true,"prefix":"","firstName":"Yutaka","middleName":"","lastName":"Koyama","suffix":""},{"id":276775734,"identity":"e664a191-565c-42cc-9fda-f2dbb72bb337","order_by":3,"name":"Shinji Tomita","email":"","orcid":"","institution":"Gifu Heart Center","correspondingAuthor":false,"prefix":"","firstName":"Shinji","middleName":"","lastName":"Tomita","suffix":""}],"badges":[],"createdAt":"2024-02-29 06:07:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3998703/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3998703/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52450645,"identity":"91ea2937-45aa-4148-b85c-7c9bd3fbfd77","added_by":"auto","created_at":"2024-03-11 19:07:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":612099,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig.11.png","url":"https://assets-eu.researchsquare.com/files/rs-3998703/v1/5598c454c0732bdd83c31c7b.png"},{"id":71837160,"identity":"fff72b90-80b9-4485-b909-a8acf36ffe56","added_by":"auto","created_at":"2024-12-19 04:24:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1021740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3998703/v1/faeea318-f97c-4e6d-8a32-4c0465117106.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving the Function of Thrombosed Aortic Bioprosthetic Valves through Anticoagulation","fulltext":[{"header":"Background","content":"\u003cp\u003eThe hypoattenuated leaflet thickening (HALT) phenomenon on computed tomography (CT), which reduces leaflet motion in both surgical and transcatheter bioprosthetic aortic valves, was first reported by Makkar and colleagues1.\u003c/p\u003e "},{"header":"Case presentation","content":"\u003cp\u003eThe patient's condition with HALT may be considered subclinical. Fourteen months ago, a 79-year-old woman underwent surgical aortic valve replacement with a 19 mm Epic Supra bioprosthetic valve (Abbott Vascular, California) for aortic stenosis. One month prior, the patient was hospitalized due to heart failure, and complained of worsening dyspnea. Echocardiography revealed an elevated pressure gradient in the aortic valve (Fig._1A), while CT revealed HALT on the right coronary cusp of the aortic bioprosthetic valve (Fig._1B diastole/systole). Following the diagnosis of a thrombosed bioprosthetic valve, anticoagulation therapy with Coumadin was initiated. The patient's dyspnea symptoms improved, and echocardiography revealed a decreased pressure gradient in the aortic valve three months after starting anticoagulation therapy (Fig._1-C). CT revealed that the HALT disappeared six months after anticoagulation therapy was initiated (Fig.\u0026nbsp;1D, diastole/systole).\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eBrown ML et al. reported that the incidence of thrombosed valves in porcine aortic bioprostheses was 0.55%, which was greater than that of stented pericardial valves\u003csup\u003e2\u003c/sup\u003e. Patients with heart failure who have a thrombosed bioprosthetic valve may require a redo aortic valve replacement. However, initiating anticoagulation therapy can potentially improve not only patients’symptoms but also their laboratory data. This includes reducing the pressure gradient of the aortic valve or eliminating HALT on CT scan, as in this case. Therefore, anticoagulation therapy should be the primary treatment option for patients with HALT of a bioprosthetic aortic valve.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eThe hypoattenuated leaflet thickening (HALT)\u003c/p\u003e\u003cp\u003ecomputed tomography (CT)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e：Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e：informed consent for publication was obtained\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e：Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e：The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e：None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.K. and M.I wrote the main manuscript text and prepared figures. All authors reviewed the manuscript.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e：Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMakkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, De Backer O, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown ML, Park SJ, Sundt TM, Schaff HV. Early thrombosis risk in patients with biologic valves in the aortic position. J Thorac Cardiovasc Surg. 2012;144(1):108\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HALT, thrombosed valve, anticoagulation","lastPublishedDoi":"10.21203/rs.3.rs-3998703/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3998703/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHypoattenuated leaflet thickening (HALT), a potential aftereffect of both surgical and transcatheter bioprosthetic aortic valve procedures, may affect valve performance and clinical outcomes. Here, we describe an elderly patient who, underwent surgical aortic valve replacement with a bioprosthetic valve for aortic stenosis (SAVR), was hospitalized due to heart failure, and complained of worsening dyspnea.\u003c/p\u003e \u003cp\u003eThe patient\u0026rsquo;s echocardiography showed an elevated pressure gradient in the aortic valve, while CT revealed HALT on the right coronary cusp of the aortic bioprosthetic valve.\u003c/p\u003e \u003cp\u003eFollowing the diagnosis of a thrombosed bioprosthetic valve, anticoagulation therapy with Coumadin was initiated. The patient's dyspnea symptoms improved, and echocardiography revealed a decreased pressure gradient in the aortic valve three months after starting anticoagulation therapy.\u003c/p\u003e \u003cp\u003eThis case highlights the significance of considering anticoagulation as the primary treatment option for patients with HALT of a bioprosthetic aortic valve.\u003c/p\u003e","manuscriptTitle":"Improving the Function of Thrombosed Aortic Bioprosthetic Valves through Anticoagulation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 19:06:34","doi":"10.21203/rs.3.rs-3998703/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc24a04a-8302-4495-9813-d8457279e8ae","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-19T04:24:07+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 19:06:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3998703","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3998703","identity":"rs-3998703","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}