Kamath Shiwani, Ulhaque Abid, Ali Rias, Frunzi Johnathan
Department of Internal Medicine, Medical Center of Trinity, Trinity, USA.
Department of Radiology, Medical Center of Trinity, Trinity, USA.
Cureus. 2021 May 15;13(5):e15046. doi: 10.7759/cureus.15046.
This case reports a 24-year-old female with prior aortic insufficiency who underwent a mechanical aortic valve replacement with subsequent transient ischemic attacks and documented subtherapeutic international normalized ratio (INR). She presented with pain and bilateral lower extremity pulselessness. Workup showed a supratherapeutic INR, no thrombus on echocardiogram, and computed tomography angiography demonstrating no flow in the bilateral common femoral arteries. Patient failed repeated thrombectomies and had a bilateral above-knee amputation. The patient was suspected to have acute on chronic emboli from the mechanical aortic valve and further testing did not elucidate contributory causes of her critical limb ischemia. We believe this is the first documented case of bilateral lower extremity ischemia due to mechanical valve complications.
本病例报告了一名24岁患有主动脉瓣关闭不全的女性，她接受了机械主动脉瓣置换术，随后出现短暂性脑缺血发作，且国际标准化比值（INR）低于治疗水平。她表现为疼痛和双下肢无脉。检查显示INR高于治疗水平，超声心动图未发现血栓，计算机断层血管造影显示双侧股总动脉无血流。患者多次血栓切除术均失败，最终进行了双侧膝上截肢。该患者被怀疑因机械主动脉瓣出现急性慢性栓塞，进一步检查未能明确导致其严重肢体缺血的原因。我们认为这是首例有记录的因机械瓣膜并发症导致双侧下肢缺血的病例。
