Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis

Egbe, Alexander C.; Pislaru, Sorin V.; Ali, Mahmoud; Khan, Aftab; Boler, Amber; Schaff, Hartzell V.; Akintoye, Emmanuel; Connolly, Heidi M.; Nkomo, Vuyisile T.; Pellikka, Patricia A.

doi:10.1016/j.jcmg.2017.06.022

Cited by 29 publications

(17 citation statements)

References 17 publications

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“…Echocardiographic plays an important role to the diagnosis of biological valve thrombosis and CT may be of added value 18 . In our patient, PV thrombosis was first revealed by TOE, and then confirmed by CT.…”

Section: Discussionmentioning

confidence: 66%

Thrombosis of a biological pulmonary valve in a young patient on anticoagulant therapy with rivaroxaban: a case report

Strozzi

Anić

Baricevic

et al. 2019

European Heart Journal - Case Reports

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Background Patients with repaired tetralogy Fallot often develop severe pulmonary regurgitation (PR) and need surgical or catheter valve replacement/implantation. Early valve failure is not expected and thrombosis of a biological valve in a mid-term period after surgery on pulmonary position is rare. Case summary We report a 33-year-old female patient, who presented with heart failure, 18 months after surgical implantation of a biological valve on pulmonary position for severe PR, after previous complete repair. The patient was on anticoagulant therapy with novel oral anticoagulants (NOACs) for paroxysmal atrial fibrillation. After revealing a big pulmonary valve (PV) thrombus as a cause of severe valve stenosis and right heart failure, patient was re-operated without complication. After surgery a long-term warfarin therapy was introduced. The patient had an uneventful 9-month follow-up. Discussion Thrombotic events after rivaroxaban therapy are rare in non-valvular disease and there is paucity of data for NOAC therapy related to valve thrombosis. In our case, severe heart failure 1 year and a half after PV replacement, in a patient taking anticoagulant therapy, was unexpected. The diagnosis of valve thrombosis was revealed by echocardiography, and confirmed by computed tomography. We did not find any sign of thrombophilia, or any mechanical reason for valve thrombosis.

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Section: Discussionmentioning

confidence: 66%

Thrombosis of a biological pulmonary valve in a young patient on anticoagulant therapy with rivaroxaban: a case report

Strozzi

Anić

Baricevic

et al. 2019

European Heart Journal - Case Reports

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show abstract

“…Interestingly, recent case series have showed a peak incidence of BVT at 13–24 months; dispelling the notion that BVT is only confined to the first few months post-valve implantation 6–8. The reported incidence of BVT is approximately 0.03%–0.78% per year 7 9 10.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical presentations of BVT range from an incidental finding in an asymptomatic patient to progressive dyspnoea, thrombo-embolic complications, syncope, acute heart failure or cardiogenic shock 8 14. Clinical features supportive of BVT include new-onset acute heart failure, a rapid rise in the mean prosthetic valve gradient compared with the initial post-operative study, presence of risk factors for BVT, new thromboembolic event and regression of heart failure symptoms with anticoagulation therapy 14…”

Section: Discussionmentioning

confidence: 99%

Very late bioprosthetic aortic valve thrombosis

2019

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A 79-year-old man with a history of bioprosthetic aortic valve (AV) replacement in 2008 and atrial fibrillation was admitted with acute pulmonary oedema. Transthoracic and transoesophageal echocardiograms revealed significantly elevated AV gradients and thickened AV leaflets. These findings were suggestive of bioprosthetic valve thrombosis (BVT). The patient was treated with intravenous heparin and commenced on vitamin K antagonist. BVT remains an under recognised cause of late prosthetic valve dysfunction. A lack of awareness of BVT occurring beyond 3 months post-implantation is likely to account for this. Furthermore, structural valve degeneration is the most common mechanism of late prosthetic valve dysfunction. Recognising the difference between the two aetiologies is crucial as the management plan differs significantly. Here, we report a case of very late bioprosthetic AV thrombosis diagnosed 8 years after implantation. This was successfully treated with systemic anticoagulation, thereby avoiding the need for redo cardiac surgery.

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“…[5] While bioprosthetic valve avoids this problem to a large extent, their structural damage over a period of follow-up equals its benefit accrued over years of freedom from thromboembolic episodes and bleeding related to anticoagulation. [6] Moreover, the bioprosthetic valve is created from tissue of xenogeneic origin; hence, it degrades with calcification and stenosis. [7] The early and long-term result at pulmonary position is dismal.…”

Section: Introductionmentioning

confidence: 99%

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

et al. 2019

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Introduction: Tetralogy of Fallot requiring transannular repair of the right ventricular outflow tract (RVOT) are exposed to free pulmonary insufficiency and hence inevitable right ventricular dysfunction. This study analyzes the function and structure of untreated autologous pericardium monocusp used to create a competent pulmonary valve. Materials and Methods: This is a retrospective analysis of 52 cases operated between December 2006 and December 2012. Untreated autologous pericardium was used for creating a competent pulmonary valve following a transannular patch. They are followed for functional and structural assessment of the pulmonary valve by echocardiography. Positron emission tomography (PET) with 18 fluorodeoxyglucose was performed in two cases for profiling the pulmonary valve. Results: Median age was 10.5 years (1–38). The follow-up was complete for 42 (80.76%) patients for 3 years and 25 (48.07%) patients for 5 years. The RVOT gradient was 42 mmHg (16–96) in the year of surgery, which reduced to 26 mmHg (10–58) and pulmonary insufficiency that was present in 8.3% of patients in 1 st year was witnessed in 22.7% in the 5 th year of follow-up. The monocusp patch was successful in creating a competent valve while maintaining its structure at 3 years; however, it became distorted and retracted at 5 years of follow-up. There was no calcification in any of the patients. PET-computed tomography confirmed the uptake of glucose by monocusp at 1 year of follow-up. Conclusion: The untreated autologous pericardium functioned well when it was used to create a competent pulmonary valve at short term and midterm. Although it changed in its structure; there was no calcification at 5 years of follow-up.

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Early Prosthetic Valve Dysfunction Due to Bioprosthetic Valve Thrombosis

Cited by 29 publications

References 17 publications

Thrombosis of a biological pulmonary valve in a young patient on anticoagulant therapy with rivaroxaban: a case report

Thrombosis of a biological pulmonary valve in a young patient on anticoagulant therapy with rivaroxaban: a case report

Very late bioprosthetic aortic valve thrombosis

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

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