Management Strategies for Recurrent Mechanical Mitral Valve Thrombosis: A Challenging Case of a Young Patient on Acenocoumarin, Presenting with Low Cardiac Output Syndrome

Mechanical mitral valve thrombosis is a serious complication following valve replacement, characterized by thrombus formation due to exposure to low-pressure blood flow in the left atrium.Various risk factors, including valve design, inadequate preoperative anticoagulation, and abnormal loading conditions, contribute to its occurrence.We illustrate the management of this challenging complication with a literature review through the case of a 22-year-old female patient who underwent mechanical mitral valve replacement and tricuspid valve repair for severe rheumatic mitral stenosis complicated by atrial fibrillation and mild pulmonary hypertension.One-year post-surgery, she developed subacute heart failure symptoms after dental surgery, and echocardiography revealed thrombus on her mechanical valve.Although she was treated with anticoagulation and showed symptom improvement, she returned a year later with acute congestive heart failure.Severe mitral regurgitation due to valve obstruction from thrombi caused shock.Urgent surgery revealed valve thrombosis with an easy weaning from cardiopulmonary bypass and a transient improvement in hemodynamic parameters before she developed septic shock originating from the lungs and subsequently passed away.Valve thrombosis has multiple causes and nonspecific symptoms.Anticoagulation is crucial for prevention, with surgery as a last resort.Comprehensive management is necessary.Integrated approach with anticoagulation, thrombolytic therapy, and surgery.Education and tailored treatment plans are crucial.Future studies should focus on novel anticoagulants.