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

Tong, Ann T.; Roudaut, R.; Özkan, Mehmet; Sagie, Alex; Shahid, Maie; Pontes, Sérgio C.; Carreras, Francesc; Girard, Steven; Arnaout, Samir; Stainback, Raymond F.; Thadhani, Ravi; Zoghbi, William A.

doi:10.1016/j.jacc.2003.08.028

Cited by 178 publications

(123 citation statements)

References 30 publications

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“…It has been reported in literature that TT should not be performed in the presence of left atrial thrombus due to the high risk of embolism (5). Furthermore, a multicenter PRO-TEE study has reported that the risk of embolism was higher with TT in patients with a thrombus area of >0.8 cm 2 (6).…”

Section: Discussionmentioning

confidence: 99%

A case of unusual looking prosthetic mitral valve thrombosis treated with low dose slow infusion tPA

Bayar

Arslan²,

Köklü³

et al. 2014

Anadolu Kardiyol Derg

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AS was of rheumatic cause, with commisural fusion and little calcification. The aortic annulus and sinuses of Valsalva diameters were 22 and 30 mm, respectively. Systolic pulmonary artery pressure was 60 mm Hg. Coronary angiography showed normal epicardial coronary arteries, the calculated logistic EuroSCORE was 21. She was declined for surgery on the basis of prior cardiac surgery and poor left ventricular function.The technique was similar to that described by the previous case. During deployment, accelerated right ventricular pacing with 140 bpm and an oversized (29 mm) CoreValve prothesis were used. Only one attempt was necessary to achieve the optimal result without any technical issues (Video 5, 6. See correspondening video/movie images at www.anakarder.com). Follow-up echocardiography showed a well functioning prosthesis, with a mean gradient of 8 mm Hg, respectively. Mild paravalvular leak was present. The patient was clinically stable at 30 days follow up after the procedure. DiscussionThe use of TAVI is considered a relative contraindication in noncalcified valves (5). Calcium seems mandotory for anchoring the stentvalve and prevent pop-out, dislocation and migration of the prosthesis. In rheumatic AS, there is little or no calcification. However, our cases show that TAVI could be safe, feasible and effective treatment in patients with rheumatic AS.The concept of TAVI is based on crushing the usually heavily calcified native valve leaflets against the aortic wall by implanting a metallic stent-frame. Since calcification of the native valve leaflets is presumably essential for fixation of the stent-frame, TAVI is indicated in patients with calcified AS. Indeed, TAVI in patients with only marginal annular calcifications may lead to dislocation of the bioprosthesis into the left ventricle (2, 4). The unique pathological features of rheumatic AS, with lack of calcium, commissural fusion and pliable leaflets, can make it unsuitable to TAVI.The CoreValve prosthesis might anchor solidly even in the absence of calcification when oversized due to engineering properties (2), and may offer treatment for rheumatic AS without dislocation and migration of the prosthesis. During deployment, to prevent pop-out, embolization and migration of the prosthesis we performed accelerated right ventricular pacing between 140-180 bpm. In addition, oversized, selfexpandable (CoreValve) valves were selected.

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Section: Discussionmentioning

confidence: 99%

A case of unusual looking prosthetic mitral valve thrombosis treated with low dose slow infusion tPA

Bayar

Arslan²,

Köklü³

et al. 2014

Anadolu Kardiyol Derg

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“…Nevertheless, recent case series demonstrate that the left-sided thrombolysis of PVT can be conducted with the complete success rate in 70-80% of patients presenting in NYHA functional classes III/IV (5). As the dose and mode of administration of thrombolytic agents deviate, major complications are being observed in the rapid infusion protocols (6). In patients with PVT, slow infusion thrombolysis guided by serial transthoracic echocardiography and fluoroscopy may be achieved with a low risk of complications and a high rate of success.…”

Section: Discussionmentioning

confidence: 99%

Successful application of thrombolysis and angioplasty in case of mechanical aortic valve and coronary graft thrombosis

Norkienė

Kažukauskienė

Samalavičius

et al. 2016

AML

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Prosthetic valve thrombosis (PVT) is a rare and fatal complication requiring immediate treatment. Optimal management of the left-sided obstructive PVT is still controversial and depends on patient's status, estimated risk of surgery, thrombus location and size, and clinician's experience. We report a case of a 71-year-old woman, presenting with signs of cardiogenic shock. Transesophageal echoscopy was used to diagnose acute obstructive thrombosis of the mechanical aortic valve. Concomitant coronary graft thrombosis was suspected due to signs of acute myocardial infarction. Thrombolysis with alteplase and subsequent stenting of the venous graft lead to successful resolution of the thrombotic lesions and a favourable patient outcome. Fibrinolytic therapy followed by angioplasty is a rational treatment alternative for inoperable or high risk patients in the case of concomitant mechanical valve and graft thrombosis.

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“…1 In this population, lytic therapy was associated with 85% success rate, overall complication rate of 18%, and mortality rate of 5.6%. 9 Treatment modalities should be tailored for patients based upon hemodynamic status, comorbidities, and informed decision.…”

Section: Treatment Of Mechanical Valve Thrombosismentioning

confidence: 99%

Treatment of mechanical valve thrombosis during pregnancy

Choi

Midwall

Chaille

et al. 2007

Clinical Cardiology

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SummaryPregnant patients with mechanical valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected, as it is critical for the health of mother and fetus. In this review, we present a pregnant patient with mechanical valve thrombosis (MVT) who underwent thrombolytic therapy, subsequent anticoagulation according to available guidelines, and delivered a healthy baby at full term.

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

Abstract: In PVT, the thrombus size imaged with TEE is a significant independent predictor of outcome. Transesophageal echocardiography can identify low-risk groups for thrombolysis irrespective of symptom severity and is therefore recommended in the management of prosthetic valve thrombosis.

Cited by 178 publications

References 30 publications

A case of unusual looking prosthetic mitral valve thrombosis treated with low dose slow infusion tPA

A case of unusual looking prosthetic mitral valve thrombosis treated with low dose slow infusion tPA

Successful application of thrombolysis and angioplasty in case of mechanical aortic valve and coronary graft thrombosis

Treatment of mechanical valve thrombosis during pregnancy

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