Abstract/Description
Background: Transcatheter aortic valve replacement (TAVR) is a cornerstone therapy for severe aortic stenosis. Up to one-third of patients develop hypoattenuated leaflet thickening (HALT) within the first year post-TAVR. HALT, a form of leaflet thrombosis, can progress to leaflet immobility and structural deterioration. Despite its significance, no unified approach exists for screening or management of HALT after TAVR.
Case Presentation: A 64-year-old woman presented with shortness of breath on exertion. Exam revealed a 3/6 systolic murmur, and echocardiogram confirmed severe aortic stenosis. She underwent TAVR with resolution of symptoms and was discharged on clopidogrel (Plavix) as single antiplatelet therapy. Two months post-procedure, she returned with recurrent symptoms; imaging confirmed overt HALT.
Discussion: Early onset HALT demonstrates that leaflet thrombosis can develop sooner than expected and suggests antiplatelet therapy alone may be insufficient, contributing to the debate on anticoagulation—either alone or combined with antiplatelet therapy—after TAVR. Guidelines recommend single antiplatelet therapy for patients without anticoagulation indications; those with indications continue anticoagulation and typically avoid antiplatelets to reduce bleeding risk. Although routine anticoagulation is generally not advised without indication, this case illustrates that monotherapy may be inadequate, emphasizing the need for standardized, evidence-based strategies to prevent HALT post-TAVR.
Conclusion: This case highlights overt HALT presenting early after TAVR, a complication usually described as subclinical and later in onset.
Faculty Advisor/Mentor
Dr Matthew Summers
Faculty Advisor/Mentor Email
mrsumme1@sentara.com
Faculty Advisor/Mentor Department
Department of Cardiology
College/School/Affiliation
Eastern Virginia Medical School (EVMS)
Included in
Cardiology Commons, Circulatory and Respiratory Physiology Commons, Medical Biotechnology Commons, Medical Pathology Commons
Development of Overt Hypo-Attenuated Leaflet Thickening Following Transcatheter Aortic Valve Replacement
Background: Transcatheter aortic valve replacement (TAVR) is a cornerstone therapy for severe aortic stenosis. Up to one-third of patients develop hypoattenuated leaflet thickening (HALT) within the first year post-TAVR. HALT, a form of leaflet thrombosis, can progress to leaflet immobility and structural deterioration. Despite its significance, no unified approach exists for screening or management of HALT after TAVR.
Case Presentation: A 64-year-old woman presented with shortness of breath on exertion. Exam revealed a 3/6 systolic murmur, and echocardiogram confirmed severe aortic stenosis. She underwent TAVR with resolution of symptoms and was discharged on clopidogrel (Plavix) as single antiplatelet therapy. Two months post-procedure, she returned with recurrent symptoms; imaging confirmed overt HALT.
Discussion: Early onset HALT demonstrates that leaflet thrombosis can develop sooner than expected and suggests antiplatelet therapy alone may be insufficient, contributing to the debate on anticoagulation—either alone or combined with antiplatelet therapy—after TAVR. Guidelines recommend single antiplatelet therapy for patients without anticoagulation indications; those with indications continue anticoagulation and typically avoid antiplatelets to reduce bleeding risk. Although routine anticoagulation is generally not advised without indication, this case illustrates that monotherapy may be inadequate, emphasizing the need for standardized, evidence-based strategies to prevent HALT post-TAVR.
Conclusion: This case highlights overt HALT presenting early after TAVR, a complication usually described as subclinical and later in onset.