A young woman presented with increasing fatigue, dyspnea, lightheadedness, and intermittent chest pain. She had a history of systemic lupus erythematosus, antiphospholipid antibody syndrome, and Libman-Sacks endocarditis, resulting in a bioprosthetic aortic valve replacement 6 months before presentation. A bioprosthetic valve was chosen at that time over a mechanical valve because of inability to consistently maintain therapeutic anticoagulation levels with warfarin. Transthoracic echocardiography was performed and showed severe aortic valve prosthetic stenosis with a mean gradient of 69 mm Hg and thickened leaflets (Figure A) with reduced mobility, consistent with bioprosthetic valve thrombosis (BPVT).
