Coronary Embolism in a Patient with Mechanical Mitral Valve: The High Cost of Anticoagulation Discontinuation

Laoufi Zaynab^1, , Lokman Hafsa¹, Benyass Aatif¹, Mouine Najat¹ and Lakhal Zouhair¹

¹Cardiology Department, Mohamed V Military Hospital, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco

Cite this paper:
Laoufi Zaynab, Lokman Hafsa, Benyass Aatif, Mouine Najat and Lakhal Zouhair. Coronary Embolism in a Patient with Mechanical Mitral Valve: The High Cost of Anticoagulation Discontinuation. American Journal of Medical Case Reports. 2025; 13(6):31-33. doi: 10.12691/ajmcr-13-6-1

Abstract

Coronary embolism is a non-atherosclerotic cause of acute coronary syndromes. It is frequently observed in patients with atrial fibrillation or prosthetic heart valves. We report the case of a 40-year-old woman with no cardiovascular risk factors but a history of mechanical mitral valve replacement, who had discontinued her vitamin K antagonist (VKA) therapy without medical supervision. She presented with sudden-onset, typical anginal chest pain at rest, described as retrosternal pressure radiating to the left arm and associated with dyspnea. Transthoracic echocardiography revealed an abnormality on the mitral prosthesis, and transesophageal echocardiography confirmed the presence of a thrombus. Coronary angiography identified a subocclusive thrombotic lesion in the mid-left anterior descending (LAD) artery, consistent with coronary embolism. The patient underwent successful manual thrombectomy without stent implantation.

Keywords:
Coronary embolism Prosthetic heart valve Thrombectomy Valve thrombosis

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Shibata T, Kawakami S, Noguchi T, et al. Prevalence, clinical features, and prognosis of acute myocardial infarction attributable to coronary artery embolism. Circulation. 2015; 132(4): 241–250.
[2]	Karakoyun S, Gürsoy MO, Kalçık M, Yesin M, Özkan M. A case series of prosthetic heart valve thrombosis-derived coronary embolism. Turk Kardiyol Dern Ars. 2014 Jul;42(5):467-71.
[3]	Lacey MJ, Raza S, Rehman H, Puri R, Bhatt DL, Kalra A. Coronary Embolism: A Systematic Review. Cardiovasc Revasc Med. 2020 Mar; 21(3): 367-374.
[4]	Garvey GJ, Neu HC. Infective endocarditis—An evolving disease: A review of endocarditis at the Columbia-Presbyterian medical center, vol. 57; 1978; 1968–73 Medicine (Baltimore).
[5]	Budavari AI, Glenn TJ, Will KK, Askew JW, Fortuin FD. A case of simultaneous pulmonary embolism and acute myocardial infarction secondary to a previously undiagnosed patent foramen ovale. J Hosp Med United States 2009; 4: E5–9.
[6]	Hernandez F, Pombo M, Dalmau R, Andreu J, Alonso M, Albarran A, et al. Acute coronary embolism: angiographic diagnosis and treatment with primary angioplasty. Catheter Cardiovasc Interv United States 2002; 55 :491–4.
[7]	Adnan G, Singh DP, Mahajan K. Coronary Artery Thrombus. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
[8]	Kotooka N, Otsuka Y, Yasuda S, Morii I, Kawamura A, Miyazaki S. Three cases of acute myocardial infarction due to coronary embolism: treatment using a thrombus aspiration device. Jpn Heart J Japan 2004; 45: 861–6.
[9]	Giri S, Hwang I, Alsafwah S. A case of left main coronary artery embolus further embolising to the left anterior descending artery. BMJ Case Rep England 2014; 2014.
[10]	Acikel S, Dogan M, Aksoy MMN, Akdemir R. Coronary embolism causing non-ST elevation myocardial infarction in a patient with paroxysmal atrial fibrillation: treatment with thrombus aspiration catheter. Int J Cardiol Netherlands 2011:e33–5.
[11]	Yokoyama Y, Briasoulis A, Ueyama H, Mori M, Iwagami M, Misumida N, Takagi H, Kuno T. Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and bioprosthetic valves: A meta-analysis. J Thorac Cardiovasc Surg. 2023 Jun; 165(6): 2052-2059. e4.
[12]	de Souza Lima Bitar Y, Neto MG, Filho JAL, Pereira LV, Travassos KSO, Akrami KM, Roever L, Duraes AR. Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis. Drugs R D. 2019 Jun; 19(2): 117-126.