Obstruction of mechanical valve prostheses: Clinical diagnosis and surgical or nonsurgical treatment

Abstract

Twenty patients underwent nonsurgical and/or surgical treatment for obstruction of mechanical prosthetic valves. The obstructed prosthetic valve was in the aortic position in 11 patients, in the mitral position in 5, and in the tricuspid position in 4. Twelve patients had a bileaflet valve (3 aortic, 5 mitral, 4 tricuspid), and 8 had a tilting disk valve (all aortic). The diagnosis of prosthetic valve obstruction was made by cineradiography and echocardiography. Thrombolytic therapy was instituted in a series of our 10 most recent patients (11 cases), except for one patient with acute renal failure, regardless of the position of the obstructed prosthetic valve. Successful thrombolysis was achieved in 6 cases (54.5%). Six patients required surgical treatment subsequent to either failed or incomplete thrombolysis, and one patient died of congestive heart failure 1 month after surgery. Nonfatal neurologic events occurred in 2 cases (18.2%). A total of 16 patients underwent surgical treatment. Two (12.6%) of the 16 patients died of causes unrelated to the operative procedures before discharge from the hospital. These results suggest that thrombolytic therapy appears to be an attractive nonsurgical alternative for valve thrombosis when the patient's clinical condition is not critical, and thus surgical treatment should only be performed in an emergency on seriously ill patients.

Prosthetic heart valve thrombosis: Pathogenesis, diagnosis and management

“…Replacement of the prosthesis is the most widely used approach but often simple removal of the thrombus (thrombectomy), in a normally functioning prosthesis is preferable [17]. It should be noted that the mortality rate of this surgery can be as high as 69%, depending on the NYHA functional class group [18,19].…”

Evaluation of Prosthetic Valve Obstruction on Electrocardiographically Gated Multidetector-Row Computed Tomography

“…Based on our previous study, 4 PVO was suspected when VI was <0.35 on TTE and when persistent restriction of leaflet motion was observed on cineradiography with the measured opening angle ≥20°. 2 In this study, PVO was principally diagnosed based on the cineradiographic criteria because previous studies have demonstrated that PVO was detected accurately and far earlier on cineradiography than on TTE. 4,11,14,16…”

Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve

“…Small valve size (B19 mm), a specific valve type (Carbomedics), an etiology of rheumatic valve disease, and young age at the time of AVR (\48.8 years) were found to be independent predictors of moderate to severe pannus. The incidence of prosthetic valve obstruction due to pannus has been known to be uncommon (0.1-4.5 % per patient-year in the aortic position) [3,12,16], but recent studies have found that prosthetic aortic valve obstruction caused by pannus is more frequent than previously reported and can be detected even in asymptomatic patients [17,18]. In our study, pannus formation was present in most cases (77.2 %), even in cases which showed a normal range of PG on TTE (71.4 %).…”

“…Pannus location was classified as focal and circumferential involvement, and focal involvement was subclassified according to a localization system based on the surgical view ( Fig. 1) [12,13].…”