THROMBOSIS OF A PROSTHETIC MITRAL-VALVE I N A PATIENT WITH THE ANTICARDIOLIPIN SYNDROME

A 40-year-old woman in whom the mitral valve had to be replaced with a prosthetic one (St. Jude's) had to be reoperated 8 months later becau se of endocarditis on the second prosthetic valve (Carbo-Medics). Four months later her general condition deteriorated progressively with co ugh and dyspnoea, requiring hospitalization. Auscultation revealed moi st rales over both lung bases; heart sounds were distant but otherwise normal. The ''international normalized ratio'' was 2.5, while erythro cyte sedimentation rate, white cell count and C-reactive protein were normal. Transthoracic echocardiography demonstrated a hardly moving mi tral valve prosthesis with an opening area of 0.8 cm. Subsequently thi s decreased further and measurement of the anticardiolipin antibody ti tre revealed an IgG fraction of 37.9 U/ml (normal up to 12 U/ml). With in 48 hours thrombolysis with streptokinase had increased the valve's opening area to 1.8 cm. The patient made an uneventful recovery under strict anticoagulation. - This case illustrates that the anticardiolip in syndrome can be a cause of an otherwise unclear genesis.