Prosthetic Valve Thrombosis in the Acute Phase of the Stroke: Relevance of Detection and Follow-Up

The catastrophic association of prosthetic mitral valve thrombosis and hemorrhagic stroke

Prosthetic valve thrombosis is a serious complication of valve replacement associated with a high mortality rate. Stroke may be the first symptom of prosthetic valve thrombosis. We present the case of a patient who visited the emergency department with symptoms of dysarthria and left hemiparesis. An examination revealed an ischemic stroke with hemorrhagic transformation, stemming from a thrombosis of their mitral valve prosthesis, which progressed to the patient's death. We emphasize the difficulty in the therapeutic and diagnostic management of these patients.

Screening of Embolic Sources by Point-of-Care Ultrasound in the Acute Phase of Ischemic Stroke

Our objective was to evaluate hand-held echocardiography as point of care ultrasound scanning (POCUS) to detect sources of embolism in the acute phase of stroke. Prospective, unicentric observational cohort study of non-lacunar ischemic stroke patients evaluated by V Scan device. The main sources of embolism (MSEs) were classified into embolic valvulopathies and severe ventricular dysfunction. We looked for atrial fibrillation (AF) predictors in strokes of undetermined etiology. MSEs were detected in 19.23% (25/130). Large vessel occlusion (LVO) (odds ratio [OR]: 4.24, 95% confidence interval [CI]: 1.01-17.85) and chronic heart failure (OR: 13.25, 95% CI: 3.54-49.50) were independent predictors of MSEs. LVO (OR: 6.54, 95% CI: 1.62-26.27) and left atrial area >20 cm² (OR: 7.01, 95% CI: 1.75-28.09) independently predicted AF. Patients with LVO and chronic heart disease may benefit from hand-held echocardiography as part of POCUS in the acute phase of ischemic stroke. Left atrial area measured was an independent predictor of AF in strokes of undetermined etiology.