ACUTE MYOCARDIAL INFARCTION WITH VESSEL OCCLUSION IN A YOUNG ADULT WITH A MECHANICAL AORTIC VALVE

ABSTRACT

Background: The occurrence of myocardial infarction (MI) with coronary vessel occlusion in an otherwise young, healthy adult with a mechanical aortic valve is rare. Case A 25-year-old male with a history of congenital AS status-post mechanical aortic valve replacement presented to the hospital with an acute MI due to thromboembolism due to subtherapeutic INR. The patient developed ventricular fibrillation en route to the emergency department. Return of spontaneous circulation was achieved after one round of CPR with synchronized cardioversion. On admission, labs were significant for high sensitivity troponin >27,000 x 3, BNP 23, INR 1.8. The patient was positive for COVID-19 but was asymptomatic. EKG showed ST elevations in leads I, AVL with reciprocal depressions in leads II, III and AVF. The patient underwent an emergent left heart catheterization which showed a normally functioning mechanical aortic valve and 100% occlusion of the mid LAD. After several rounds of balloon angioplasty, a thrombus was aspirated, mechanical thrombectomy was performed and a drug-eluding stent was deployed under IVUS guidance with restoration of TIMI 3 flow. A transthoracic echocardiogram following PCI showed an ejection fraction of 40% with anterior wall hypokinesis and mean aortic valve gradient of 10mmHg. The patient followed up in clinic two months later and was doing well. Decision-making The effect of valvular heart disease on heart failure and cardiogenic shock is well studied. However, the occurrence of myocardial infarction due to thromboembolism in young patients with a subtherapeutic INR in the setting of mechanical aortic valve is not well described in literature. Conclusion: This case highlights both the importance of compliance with anticoagulation in patients with mechanical valves and a rare cause of myocardial infarction;i.e., non-compliance with anticoagulation in the setting of mechanical aortic valve. In addition, COVID-19 has been well established as a prothrombotic disease process, adding to the plot of this unusual case.