Author/Authors :
Montenegro Sá, Fernando Cardiology Department - Leiria Hospital Center, Portugal , Fernandes, Sara I. L. Cardiology Department - Leiria Hospital Center, Portugal , Carvalho, Rita J. R. Cardiology Department - Leiria Hospital Center, Portugal , Santos, Luís M. G. Cardiology Department - Leiria Hospital Center, Portugal , Antunes, José A. S. Cardiology Department - Leiria Hospital Center, Portugal , Guardado, Joana M. Cardiology Department - Leiria Hospital Center, Portugal , Morais, João C. A. Cardiology Department - Leiria Hospital Center, Portugal
Abstract :
Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-
year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an
acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic
echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for
the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was
then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract.
After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case
since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a
standardly accepted therapeutic INR.
