Thrombosis of mitral valve prosthesis presenting as abdominal pain

A 67-year-old woman presented with abdominal pain, anemia, and leukocytosis . Five years previously the patient had undergone mitral valve replacement with a St. Jude bileaflet mechanical prosthesis. After her admission, echoc ardiography confirmed an immobile leaflet of the prosthetic valve. At urgen t surgery, thrombosis and pannus, obstructing the disc, were found, and the mechanical valve was replaced with a bioprosthesis. The incidence of mitra l valve thrombosis is low, ranging from 0.1% to 5.7% per patient per pear. Patients who receive inadequate anticoagulation, particularly with valve pr ostheses in the mitral position, have an increased risk for thrombus or pan nus formation. Presentation varies, from symptoms of congestive heart failu re or systemic embolization, to fever or no symptoms. New or worsening symp toms in a patient with a prosthetic heart valve should raise concerns about prosthetic dysfunction. Aggressive investigation and, if indicated, urgent or emergency surgery for treatment can be lifesaving.