Abstract: TH-PO104
Recurrent Bilateral Renal Artery Thromboembolism as a Late Complication of Bentall Procedure with Mechanical Aortic Valve
Session Information
- AKI: Clinical, Outcomes, and Trials - Epidemiology and Pathophysiology
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Salvatierra, Juan, Hamilton Medical Center, Dalton, Georgia, United States
- Rao, Rohini, Riverview Regional Medical Center, Gadsden, Alabama, United States
- Duchesne, Rafael O., Hamilton Medical Center, Dalton, Georgia, United States
Introduction
Thromboembolic events are uncommon in patients who have undergone ascending aorta replacement with an aortic graft and composite (mechanical or bioprosthetic) valve, also known as Bentall procedure. We present a rare case of recurrent bilateral renal infarction from a cardioembolic source, i.e. Bentall procedure with mechanical aortic valve.
Case Description
A 51-year-old man with history of right renal infarct and non-insulin-dependent diabetes presented to the emergency department complaining of left flank pain of 1 hour duration. He was compliant with warfarin. He had undergone Bentall procedure with mechanical valve for bicuspid aortic valve fifteen years before.
Examination revealed blood pressure 143/101 mmHg, a systolic murmur with opening and closing click and left flank tenderness. Laboratory analyses showed leukocytosis, creatinine 2.5 mg/dL (baseline 1.4), INR 1.64, 2+ proteinuria and 1+ hematuria. CT angiography of the abdomen revealed a clot within an anterior branch of the left renal artery and a large infarct. He was started on unfractionated heparin and hydromorphone via PCA pump. Vascular surgery deemed him not a revascularization candidate for being outside an 1-hour window. He was managed expectantly and maintained good urine output with stable creatinine. He was discharged home on a higher warfarin dose with enoxaparin bridging. On three-week follow-up, he felt well and creatinine had improved to 2 mg/dL, INR 2.45 was below goal of 2.5-3.5.
Discussion
Renal infarct should be a differential diagnosis of flank pain in patients with prosthetic heart valves. Our patient’s multiple thromboembolic events were secondary to subtherapeutic INR in the setting of Bentall procedure. Revascularization with percutaneous endovascular rather than surgical approach is preferred if feasible. In patients with a mechanical valve, anticoagulation with unfractionated or low molecular weight heparin is recommended.