Early Failure of a Bioprosthetic Valve in the Pulmonary Position Causing Panic

An asymptomatic 26-year-old woman with repaired tetralogy of Fallot and a bioprosthetic pulmonary valve presented with a large thrombosis occluding most of her right ventricular outflow tract and main pulmonary arteries. Our pulmonary embolism response team was emergently consulted, resulting in considerable discussion regarding the treatment modality given the large size and high-risk nature of the thrombosis. Ultimately, she was started on a heparin infusion until she could undergo open thrombectomy and pulmonary valve repeat replacement. The patient's asymptomatic presentation, despite the considerable clot burden, complicated our approach to management but ultimately led to a measured and timely intervention. (C) 2022 by The Society of Thoracic Surgeons

Automated summary

This article reports a case of a 26-year-old asymptomatic woman with repaired tetralogy of Fallot and a bioprosthetic pulmonary valve, who presented with a large thrombosis occluding her right ventricular outflow tract and main pulmonary arteries. The choice of treatment modality was complicated by the patient's asymptomatic presentation, but a successful intervention was achieved through heparin infusion and surgical thrombectomy.