Mitral bioprosthetic valve thrombosis before and after anticoagulant therapy

(A) The transesophageal echocardiographic image and movie on the left demonstrate a typical appearance of bioprosthetic valve thrombosis, with soft echodense material deposited on the downstream surface of the mitral valve, inside the cusp body. The thrombus impedes leaflet motion and may thus induce prosthetic valve stenosis; prosthetic valve regurgitation may also be induced.
(B) The transesophageal echocardiographic image and movie on the right were obtained after four weeks of vitamin K antagonist (warfarin) therapy. There is near resolution of thrombus with only minute amounts of echodense material adjacent to the prosthetic posts. Mitral bioprosthetic leaflet mobility is now normal.