Transesophageal Echocardiography for the Diagnosis and Management of Nonobstructive Thrombosis of Mechanical Mitral Valve Prosthesis

Abstract

Transesophageal echocardiography appears to be a reliable method to diagnose thrombi on a mechanical mitral valve prosthesis, even when transthoracic Doppler echocardiographic parameters appear to be normal. Transesophageal echo assessment of thrombus size may be helpful in deciding whether a patient with mitral prosthesis should be treated by anticoagulation, thrombolysis, or valve rereplacement.

Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry

“…Transesophageal echocardiography (TEE) is currently the test of choice for evaluating the mechanism of prosthetic valve obstruction (23) and allows the quantitation of thrombus burden (24,25). Whether TEE is helpful in identifying structural or functional parameters that can risk-stratify patients undergoing thrombolysis has not been previously investigated.…”

Clinical significance of early thrombosis after prosthetic mitral valve replacement

“…A number of recent studies with transesophageal echocardiography (TEE) have identified a high incidence of nonobstructive thrombi (NOT) in the early postoperative period after mechanical mitral valve replacement (MMVR) (1)(2)(3)(4)(5). Such phenomena are known to increase morbidity and mortality and are often the consequence of inadequate anticoagulant therapy in the highly unstable period after surgery (3,6,7).…”

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary

“…Fibrinolytic therapy for a left-sided prosthetic valve obstructed by thrombus is associated with significant risks (cerebral emboli in 12% to 15% of cases) and is often ineffective. Fibrinolytic therapy in such patients is reserved for those in whom surgical intervention carries a high risk and those with contraindications to surgery (573)(574)(575)(576)(577)(578)(579)(580).…”