Stroke secondary to calcific bicuspid aortic valve: Case report and literature review

Background: Aortic valve calcification is common in rheumatic endocarditis, elderly patients, and congenital bicuspid aortic valve. It is not a recognized risk factor for stroke. We report a case of non-calcific embolization from calcified bicuspid aortic valve. Methods: A 52-year-old mate with bicuspid aortic valve presented with aphasia and right arm weakness of less than 3 h duration. CT head revealed hypodensity in the left middle cerebral. artery (MCA) distribution and laboratory testing showed factor V leiden heterozygosity. The patient improved after intra-arterial tissue plasminogen activator (t-PA), but developed recurrence of right sided hemiparesis and silent myocardial infarction (MI). Cerebral angiography revealed clot in the left MCA. The patient received t-PA followed by transcatheter clot retrieval and was started on anticoagulation. Conclusions: Embolization from calcific bicuspid aortic valves can lead to stroke and MI. Conservative management with anticoagulation for treatment of associated poststagnation thrombosis or aortic valve replacement as treatment is debatable. This patient was successfully managed with anticoagulation. (C) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.