Yavuzgil, OOzerkan, FGurgun, CZoghi, MCan, LAkin, M2019-10-272019-10-2720020730-2347https://hdl.handle.net/11454/35572Thromboembolism is still one of the most important complications of prosthetic heart valves. Embolism to a major coronary branch is rare, but acute proximal occlusions can be fatal, even when the coronary arteries are otherwise normal and intervention is rapid. We report a fatal complication of an exercise test in a patient who had a St. Jude bileaflet mitral valve. After an exercise test, a 42-year-old woman with a mechanical prosthetic valve had a severe hemodynamic collapse with acute ST segment changes. Coronary angiography showed a totally occluded left main coronary artery with TIMI grade 0 to I flow. Rapid injection of contrast material and the passage of a floppy guidewire through the thrombus restored a TIMI grade 3 flow. Angiography showed no coronary atherosclerostic involvement. Despite successful coronary reperfusion, intra-aortic balloon counterpulsation, and intensive medication, the patient died. This case demonstrates that exercise testing should be applied with great caution in patients with prosthetic valves, and only after a careful evaluation of valve function, We recommend transesophageal echocardiography prior to exercise testing in these patients.eninfo:eu-repo/semantics/closedAccesscase reportcoronary thrombosis/etiologyexercise testfemaleheart valve prosthesismiddle agemitral valvemyocardial infarctionprosthetic heart valvesthromboembolism/etiologyArticle2914850WOS:00017488160001211995851N/A