Transesophageal Echocardiography in the Detection of Prosthetic Mitral Valve Thrombosis Caused by Inadequate Anticoagulation

Intracranial hemorrhage resulting from oral anticoagulation in patients with prosthetic heart valves is rare. If it occurs, however, the anticoagulation treatment should be immediately reversed. The difficulty is to decide when to resume treatment. Without anticoagulation, the patient is at high risk of valve thrombosis and systemic embolization. We report a patient with a prosthetic mitral valve who developed intracranial hemorrhage as a complication of anticoagulation. Reinstitution of warfarin was delayed, and she developed severe valvular thrombosis with pulmonary edema. This was promptly diagnosed using bedside transesophageal echocardiography, and surgery was successfully carried out. Warfarin was restarted 4 days after surgery without further sequelae