Bioprosthetic valve thrombosis in carcinoid heart disease

Abstract

Tricuspid regurgitation in carcinoid syndrome leads to significant morbidity and mortality that may warrant a tricuspid valve replacement. However, for patients with high serotonin levels and known hypercoagulable risks, the optimum timing for surgery and postoperative anticoagulation approaches remain unclear. High serotonin-triggered hypercoagulability makes prosthetic valves susceptible to thrombosis. Despite appropriate management with a somatostatin analog, some patients continue to have high markers of serotonin that causes platelet aggregation and rapid clot formation. In severely symptomatic patients who require valve surgery, it may not be feasible to postpone surgery until these metabolites are normalized, which may add a substantial risk for postoperative valve thrombosis to an otherwise uneventful procedure. In some, there is a significant need to predict and prevent bioprosthetic valve thrombosis in carcinoid heart disease and to identify best anticoagulation practices across a spectrum of its complex coagulation dynamics and clinical presentation.

The clinical profile and treatment of prosthetic valve thrombosis A multi center study

“…Similar studies were identified in our analysis, and the mitral valve was most frequently correlated with thrombosis, while the aortic valve was only involved in 15% of cases, According to previous research, this study indicated that the incidence of mitral PV thrombosis was 2-3 times greater than the frequency of aortic prosthesis. These results were consistent with those of Gupta et al 13 . that indicated that 84% of patients with mitral position had PVT episodes.…”

Incidental Diagnosis of Carcinoid Disease by Intraoperative Transesophageal Echocardiography and Subsequent Discovery of a Neuroendocrine Tumor during Cardiac Surgery

“…9 Although bioprosthetic valves allow avoidance of permanent anticoagulation, new fibrous plaques may deposit on bioprosthetic valves because of continual circulation of NET secretions and lead to eventual degeneration of the valve. 10 Although rare, plaque deposition may occur at 3 to 8 years postoperatively. 11 Median survival time after valve replacement has been estimated to be 6 to 11 years.…”

Management of Intracranial Hemorrhage in the Setting of Mechanical Heart Valve Replacement Therapy

“…Slow blood flow Turbulence Incomplete apposition [80,81], Hypercoagulability [82,83], Turbulence [84,85], and Incomplete apposition [86,87] can be found through the cited sources. See [2] for a more detailed list of factors involved in prosthetic valve thrombosis.…”

“…Hemostatic and hemodynamic factors involved in the development of prosthetic valve thromboses. Additional information regarding Slow blood flow[80,81], Hypercoagulability[82,83], Turbulence[84,85], and Incomplete apposition[86,87] can be found through the cited sources. See[2] for a more detailed list of factors involved in prosthetic valve thrombosis.…”