P98 A CASE OF “RECURRENT” AORTIC VALVE STENOSIS

Abstract Clinical Case A 80–year–old man underwent coronary angiography in 2006 because of stable angina. There was chronic total occlusion middle left anterior descending artery requiring percutaneous intervention. In 2009 he for recurrent angina: a severe stent restenosis treated with stenting (DES BMS). The patient subsequently asymptomatic till 2018 when complained exertional dyspnea and Stent patency aortic valve stenosis (AVA 0.85 cm2) were documented. successful transcatheter implantation discharged dual antiplatelet therapy (DAPT) (Asa 100 mg Clopidogrel 75 mg). echocardiographic follow–up unremarkable (mean prosthetic gradient 17 mmHg, DVI=0.45). July 2021 during cardiological check the bruising: ASA discontinued. February 2022 suffered from an dipyridamole stress–echocardiography failed to demonstrate inducible ischemia, although experienced angina at peak load step. Transthoracic echocardiogram (TTE) revealed high mean trans–prosthetic (52 DVI=0.18). trans–esophageal (TEE) showed reduced mobility thickened non–coronary leaflets. hypothesis thrombosis, warfarin (INR range 2–3) started after stopping clopidogrel. After three months TTE normalized gradients (17 DVI=0.5). When 6 month–period anticoagulant accomplished, stopped DAPT administered again. September worsening chest pain on exertion. At (46 mmHg) increased. new TEE thickening right leaflets, suggestive thrombosis. DAPT, again good result 12 Conclusion Thrombosis prothesis is infrequent event usually occurring early post–implantation period. our case it occurred four years following interruption. likely initial degeneration together simplification may have had causative role. Since proved efficacy limited experience DOAC this field, given sine die.