Prosthetic mitral valve thrombosis, malfunction, and paroxysmal mitral regurgitation

Moorthy, Nagaraja; Ananthakrishna, Rajiv; Rao, Dattatreya P.V.; Manjunath, S; Nanjappa, Manjunath Cholenahally

doi:10.1111/echo.13831

Cited by 4 publications

(3 citation statements)

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“…At 5 years postoperatively, we found a cumulative mortality rate of 17.0% after mitral valve repair and 24.9% after replacement. Although our results demonstrate time‐independent hazards, mortality in the replacement group may be driven by greater acute and subacute postoperative complications in the replacement group, such as a higher likelihood of atrioventricular groove disruption, 22,23 paravalvular leakage, 24,25 and valve thrombosis 26 in mitral valve replacement. In long‐term survival studies, Silaschi et al 7 found a 5‐year survival benefit of mitral valve repair over replacement in elderly patients in both unadjusted analyses (74.2% vs. 61.0%, p < 0.01) and in adjusted analyses (76.9% vs. 58.6%, p = 0.03), respectively.…”

Section: Commentmentioning

confidence: 58%

Midterm outcomes of mitral valve repair versus replacement in elderly patients: A propensity score‐matched analysis

Muncan

Amabile

Kalogeropoulos

et al. 2022

Journal of Cardiac Surgery

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Background: Current literature reports better short-term mortality rates in mitral valve repair over replacement in elderly patients. However, valve durability, postoperative complications, and reintervention rates in these cohorts remain understudied. As such, we aimed to investigate 5-year rates of mortality and reoperation after initial mitral repair or replacement in elderly patients.Methods: Using the TriNetX Research Network database, we identified patients aged ≥70 who underwent mitral valve repair or replacement for nonrheumatic mitral insufficiency between January 2010 and December 2020. We 1:1 propensity scorematched cohorts for 33 covariates including demographics, comorbidities, and surgical history. After matching, we compared 5-year mortality and reoperation rates between cohorts using Kaplan-Meier estimates and multivariable Cox proportional hazards models.Results: We compared 823 mitral valve repair patients to a propensity scorematched cohort of 823 mitral valve replacement patients over a 5-year follow-up period. All variables of interest were adequately matched. Cumulative 5-year mortality rate was significantly lower among mitral valve repair patients (17.0% vs.

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Section: Commentmentioning

confidence: 58%

Midterm outcomes of mitral valve repair versus replacement in elderly patients: A propensity score‐matched analysis

Muncan

Amabile

Kalogeropoulos

et al. 2022

Journal of Cardiac Surgery

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“…Intermittent malfunction is a rare but potentially serious complication of PHV replacement . It may be observed in both mitral and aortic valve prosthesis and may lead to either paroxysmal obstruction or regurgitation, depending on the valve location and on the phase of the cardiac cycle during which the leaflet is entrapped. The most frequently encountered causes of intermittent valve malfunction are pannus formation, prosthetic valve thrombosis, vegetations, remnants of subvalvular apparatus such as chordae tendineae and suture material .…”

Section: Case Presentationmentioning

confidence: 99%

Intermittent malfunction and regurgitation of a mitral prosthetic valve due to entrapment by a residual subvalvular apparatus

et al. 2018

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Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve (PHV) replacement. It may be observed in both mitral and aortic valve prosthesis and may lead to either paroxysmal obstruction or regurgitation, depending on the valve location and on the phase of the cardiac cycle during which the leaflet is entrapped. The most frequently encountered causes of intermittent valve malfunction are pannus formation, prosthetic valve thrombosis, vegetations, and remnants of subvalvular apparatus such as chordae tendineae and suture material. Intermittent severe regurgitation of PHV due to residual chordae tendineae is very rare clinical entity, and transesophageal echocardiography is an indispensable guide in the differential diagnosis. Here, we represent an interesting case of intermittent regurgitation of a mitral prosthetic valve due to entrapment by a residual subvalvular apparatus.

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“… 6 , 7 The most frequently reported causes of intermittent disk dysfunction include pannus formation, entrapment of the disk by thrombi (nonobstructive or obstructive), subvalvular mitral tissue, suture material, vegetations, ventricular myocardium, and arrhythmia. 4 , 5 , 8 , 9 A multimodality approach that includes transthoracic echocardiography (TTE), 2-dimensional (2D) or real-time 3-dimensional (RT-3D) transesophageal echocardiography (TEE), cardiac computed tomography (CT), and fluoroscopy may help the diagnosis of intermittent malfunction of the PHV. 10 If not treated appropriately, intermittent dysfunction can lead to permanent disc immobilization and have more catastrophic consequences.…”

Section: Introductionmentioning

confidence: 99%

Lessons Learned From Intermittent Dysfunction of Mechanical Heart Valve

Kalkan¹,

Güner²,

Kalçık³

et al. 2022

The Anatolian Journal of Cardiology

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Background: Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve replacement. This study aimed to describe the clinical features and etiologic causes of patients with intermittent mechanical prosthetic heart valve dysfunction. Methods: Between 2010 and 2021, 16 patients who were evaluated in the echocardiography laboratory of Koşuyolu Training and Research Hospital with the diagnosis of intermittent malfunction of prosthetic valves were included in the study. Results: The evaluated patients consisted of 12 bi-leaflet mitral valve replacements and 2 mono-leaflet mitral valve replacements. The underlying causes of intermittent malfunction were classified as follows: residual chord (n = 4), obstructive thrombus (n = 2), non-obstructive thrombus (n = 2), vegetation (n = 2), pannus and obstructive thrombus coexistence (n = 1), and solely pannus (n = 1). One of the patients with mono-leaflet mitral valve replacements had pannus and obstructive thrombus. In the other patient with mono-leaflet mitral valve replacement, a stuck valve was observed in 1 of 12 beats secondary to arrhythmia. There were also 2 patients with aortic valve replacements. One patient had moderate aortic regurgitation due to prominent calcification and the other had moderate obstruction due to pannus. In the patient with pannus, a stuck leaflet was observed in 1 of 6 beats and moderate aortic regurgitation arose in 1 of 2 beats in the patient with calcification. Conclusions: The intermittent stuck valve may have catastrophic outcomes. When making a treatment decision in these patients, assessing the degree of regurgitation or stenosis is essential. In particular, the frequency of entrapment should be taken into consideration when deciding the optimal therapy for intermittent prosthetic heart valve dysfunction.

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Prosthetic mitral valve thrombosis, malfunction, and paroxysmal mitral regurgitation

Cited by 4 publications

References 0 publications

Midterm outcomes of mitral valve repair versus replacement in elderly patients: A propensity score‐matched analysis

Midterm outcomes of mitral valve repair versus replacement in elderly patients: A propensity score‐matched analysis

Intermittent malfunction and regurgitation of a mitral prosthetic valve due to entrapment by a residual subvalvular apparatus

Lessons Learned From Intermittent Dysfunction of Mechanical Heart Valve

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