Mechanical prosthetic valve thrombosis in current era: 5-year follow-up

Mahindru, Supaksh; Pande, Shantanu; Malhotra, Pulkit; Thukral, Ankit; Kotwal, Ankush Singh; Gupta, Rajan Prasad; Garg, Naveen; Kapoor, Aditya; Agarwal, Surendra Kumar

doi:10.1007/s12055-020-01041-9

Cited by 4 publications

(2 citation statements)

References 33 publications

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“…We saw that our thrombolytic treatment for 3 mm thrombus is enough. Antiagregant treatment added to warfarin therapy in discharge [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Myocardial infarction due to coronary embolism after mechanical aortic valve replacement: a case report

Kus,

Karaagac,

Bozkurt

et al. 2024

J Cardiothorac Surg

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Prosthetic valve thrombosis (PVT) in aortic valve and its complication coronary embolism is a very rare condition. Diagnosis and treatment process is challenging. We present a young patient with acute myocardial infarction who underwent mechanical aortic valve replacement (AVR) operation one month earlier. Percutaneous coronary intervention was performed and it was succesful. Transeasophageal ecocardiography (TEE) was performed. Thrombus was seen on the mechanical aortic valve and thrombolytic therapy was initiated. Control TEE was performed and there was no signs of thrombi. The patient was discharged healthfully with anticoagulant and antiaggregan.

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“…We saw that our thrombolytic treatment for 3 mm thrombus is enough. Antiagregant treatment added to warfarin therapy in discharge [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Myocardial infarction due to coronary embolism after mechanical aortic valve replacement: a case report

Kus,

Karaagac,

Bozkurt

et al. 2024

J Cardiothorac Surg

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“…That explains the higher number of patients with mitral valve prosthetic thrombosis than aortic valve prosthesis in our study population. Higher proportion of mitral valve prosthetic thrombosis than aortic valve prosthetic valve thrombosis was reported by a study conducted in India [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment outcome of patients with prosthetic stuck valves at the Cardiac Center of Ethiopia

Tadesse

Gebru²,

Tekleab

2023

PLoS ONE

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Background Prosthetic Valve Thrombosis (PVT) is rare but life threatening condition which requires urgent intervention. Patient treatment outcome is not well studied in resource limited settings and the current study aims to explore the treatment outcome of patients with PVT at the Cardiac Center of Ethiopia. Methods The study was conducted at the Cardiac Center of Ethiopia which provides heart valve surgery. All patients who were diagnosed and managed for PVT in the center during the period July 2017 to March 2022 were included in the study. Data were collected through chart abstraction by using a structured questionnaire. Data analysis was done using SPSS version 20.0 for windows software. Result Eleven patients (13 episodes of stuck valve) with PVT were included in the study and nine of them were female. The median age was 28 years old (IQR 22.5–34.0) with the youngest and oldest patients being 18 and 46 years old respectively. All the patients had bi-leaflet prosthetic mechanical valves (10 at mitral valve, two at aortic and mitral and one at aortic positions). The median duration of valve replacement before having PVT was 36 months (IQR 5–72). All patients reported good adherence to anticoagulant therapy; yet only five had optimal INR value. Nine patients presented with failure symptoms. Eleven patients received thrombolytic therapy and nine of them responded to it. One patient operated for failed thrombolytic therapy. Two patients responded to heparinization and optimization of anticoagulant therapy. Of the ten patients who received streptokinase, two of them developed fever and one patient developed bleeding as a complication of the treatment. All the patients survived hospital discharge. Conclusion Prosthetic valve thrombosis was accompanied by sub-optimal anticoagulant therapy. Most patients responded to medical therapy alone.

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Dual mechanical valve thrombosis resolution through thrombolytics: a case series

McGuire,

Yang,

Papolos

et al. 2023

European Heart Journal - Case Reports

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Background Prosthetic valve thrombosis (PVT) is a severe complication of mechanical valve replacement. Simultaneous thrombosis of multiple prosthetic valves is rare and is associated with worse outcomes. Treatment options include anticoagulation, thrombolysis, and redo operative valve replacement, with rare reports of adjunctive balloon valvuloplasty. There is limited evidence to guide therapeutic selection, specifically dosing, timing and duration of thrombolysis. The following case series highlights the importance of successful thrombolytic management in dual PVT with high bleeding risk defined as a coagulopathy with elevated international normalized ratio (INR) greater than 3 and New York Heart Association Class (NYHA) III-IV heart failure. Case Summary We describe two patients with concomitant aortic and mitral PVT. Both patients presented in NYHA Class III-IV heart failure with different challenges to surgical treatments including high bleeding risk from coagulopathy, and history of multiple prior sternotomies. After multidisciplinary discussions, both patients underwent a combination of low-dose, slow or ultra-slow infusion of tissue plasminogen activator (tPA), with resolution of their dual PVT seen on cine-fluoroscopy imaging as freely moving mechanical leaflets and improvement of heart failure symptoms back to baseline NYHA class II or lower. Discussion PVT is a complex medical condition requiring a multidisciplinary team to evaluate the best course of treatment. A trial of pharmacologic thrombolysis is often the first attempted treatment for obstructive PVT, although surgery is recommended for patients with NYHA IV symptoms, or with contraindications to thrombolysis, including high bleeding risk. However, in patients with high bleeding risk and NYHA Class III-IV heart failure, especially with surgical contraindications, low dose thrombolytics, with slow or ultra-slow infusions may still be safe and effective treatment strategies for multi-valve PVT. Further research is needed to guide thrombolysis in multi-valve PVT.

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Mechanical prosthetic valve thrombosis in current era: 5-year follow-up

Cited by 4 publications

References 33 publications

Myocardial infarction due to coronary embolism after mechanical aortic valve replacement: a case report

Myocardial infarction due to coronary embolism after mechanical aortic valve replacement: a case report

Treatment outcome of patients with prosthetic stuck valves at the Cardiac Center of Ethiopia

Dual mechanical valve thrombosis resolution through thrombolytics: a case series

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