Bioprosthetic valve thrombosis: The eyes will not see what the mind does not know

Pislaru, Sorin V.; Pellikka, Patricia A.; Schaff, Hartzell V.; Connolly, Heidi M.

doi:10.1016/j.jtcvs.2015.03.012

Cited by 16 publications

(11 citation statements)

References 8 publications

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“…The estimated prevalence of BPVT in the tricuspid position is 12%, resulting in early failure of the valve usually occurring within 5 years of implantation. BPVT of a tricuspid bioprosthesis is usually insidious in presentation and results from an elevation in central venous pressure, which symptomatically is much less dramatic than left-sided valve thrombosis with a resultant elevation in left atrial pressure and pulmonary edema [13,16]. Pathognomonic signs of BPVT include an acute rise in transvalvular gradient of more than 50% over baseline in the short-to medium-term, paroxysmal atrial fibrillation, increased cusp thickness, decreased cusp mobility, and sub-therapeutic international normalized ratio [16].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Tricuspid Valve Replacement: Two Cases of Valve-in-Valve and Valve-in-Ring

Zhou¹,

Aboulhosn²

2017

jshd

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Section: Discussionmentioning

confidence: 99%

Percutaneous Tricuspid Valve Replacement: Two Cases of Valve-in-Valve and Valve-in-Ring

Zhou¹,

Aboulhosn²

2017

jshd

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“…Aggressive sharing of the experience and the knowledge of BPVT can promote early awareness of BPVT. 5 Pislaru et al 4 emphasized that the detection of BPVT has been increasing steadily in association with the growing awareness of BPVT. In our case, we had no experience of BPVT before we encountered this case.…”

Section: Discussionmentioning

confidence: 99%

“…An algorithm for a systematic approach to BPVT has recently been proposed. 4 This algorithm is characterized by providing adequate education to the cardiologists and surgeons regarding BPVT as the first step in the accurate diagnosis and treatment. Aggressive sharing of the experience and the knowledge of BPVT can promote early awareness of BPVT.…”

Section: Discussionmentioning

confidence: 99%

“…7 Surgical intervention is preferred for the patients with NYHA class III or IV, or with a mobile or large thrombus. 4 In our case, we selected medical therapy with anticoagulant using heparin and warfarin because the masses were immobile and borderline in size (10 mm), and the hemodynamic condition was quite stable after treatment for heart failure. Although the anticoagulation was started half a year after detection by TTE, the thrombus disappeared and TPPG decreased to normal.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of porcine bioprosthetic mitral valve thrombosis with anticoagulation

Hamamoto

Kobayashi

Ozawa

et al. 2016

Cardiovascular and Thoracic Open

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A 70-year-old man underwent mitral valve replacement using a porcine bioprosthesis for infective endocarditis. Transthoracic echocardiography revealed thickened leaflets with increased transprosthetic pressure gradient and new regurgitation, 6 months after surgery. He was followed up medically with the diagnosis of early valve degeneration. He ultimately presented with worsening orthopnea 13 months after surgery. Transesophageal echocardiography revealed an immobile round mass attached to the ventricular aspect of the leaflets, which hampered valve opening, suggesting bioprosthetic valve thrombosis. Anticoagulation with heparin and warfarin were effective and transthoracic echocardiography showed normal transprosthetic pressure gradient and disappearance of regurgitation 2 months later.

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“…Histological observations raise a concern that fibrin depositions occur on prosthetic valve leaflet tissue even without an ongoing infection. 7,8 As the native valve endothelium is resistant to bacterial adhesion, endothelial lesions along with the demonstrated fibrin depositions might be a critical precursor of bacteria and platelet attachment. It has been shown that the plasma protein fibrinogen and the platelet receptor α IIb β 3 mediate S. aureus adhesion to bovine jugular vein tissue.…”

mentioning

confidence: 99%

Staphylococcus aureusadheres avidly to decellularised cardiac homograft tissue in vitro in the fibrinogen-dependent manner

et al. 2020

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Objective: Infective endocarditis remains a severe complication associated with a high morbidity and mortality in patients after heart valve replacement. Exploration of the pathogenesis is of high demand and we, therefore, present a competent model that allows studying bacterial adherence and the role of plasma fibrinogen in this process using a new in-house designed low-volume flow chamber. Three cardiac graft tissues used for pulmonary valve replacement have been tested under shear conditions to investigate the impact of surface composition on the adhesion events. Methods: Tissue pieces of cryopreserved homograft (non-decellularised), decellularised homograft and bovine pericardium patch were investigated for fibrinogen binding. Adherence of Staphylococcus aureus to these graft tissues was studied quantitatively under flow conditions in our newly fabricated chamber based on a parallel plates’ modality. The method of counting colony-forming units was reliable and reproducible to assess the propensity of different graft materials for bacterial attachment under shear. Results: Bacterial perfusions over all plasma-precoated tissues identified cryopreserved homograft with the lowest affinity for S. aureus compared to decellularised homograft presenting a significantly higher bacterial adhesion (p < 0.05), which was linked to a more avid fibrinogen binding (p < 0.01). Bovine pericardial patch, as a reference tissue in this study, was confirmed to be the most susceptible tissue graft for the bacterial adhesion, which was in line with our previous work. Conclusion: The two studied homograft tissues showed different levels of bacterial attachment, which might be postulated by the involvement of fibrinogen in the adhesion mechanism(s) shown previously for bovine tissues.

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Bioprosthetic valve thrombosis: The eyes will not see what the mind does not know

Cited by 16 publications

References 8 publications

Percutaneous Tricuspid Valve Replacement: Two Cases of Valve-in-Valve and Valve-in-Ring

Percutaneous Tricuspid Valve Replacement: Two Cases of Valve-in-Valve and Valve-in-Ring

Treatment of porcine bioprosthetic mitral valve thrombosis with anticoagulation

Staphylococcus aureusadheres avidly to decellularised cardiac homograft tissue in vitro in the fibrinogen-dependent manner

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