Diagnosis of Left-Sided Mechanical Prosthetic Valve Thrombosis: A Pictorial Review

Abstract

Although transcatheter valve therapy is rapidly evolving, surgical valve replacement is still required in many patients with severe left-side valve stenosis or regurgitation, the mechanical bi-leaflet heart valve being the standard prosthesis type in younger patients. Moreover, the prevalence of valvular heart disease is steadily increasing, especially in industrialized countries, and the problem of lifelong efficient anticoagulation of these patients remains fundamental, especially in the context where vitamin K antagonists continue to be the current standard of anticoagulation despite a level of oscillating anticoagulation. In this setting, avoiding prosthetic valve thrombosis after surgery is the number one objective for both the patient and the responsible physicians. Although rare, this complication is life threatening, with the sudden onset of acute cardiac failure such as acute pulmonary edema, cardiogenic shock, or sudden cardiac death and inadequate anticoagulation remaining the leading cause of prosthesis thrombosis, along with other risk factors. The availability of multimodal imaging techniques enables and encompasses to a full extent the diagnosis of mechanical valve thrombosis. The gold-standard diagnostic methods are transthoracic and transesophageal echocardiography. Moreover, 3D ultrasound has undoubted value in giving a more accurate description of the thrombus’s extension. When transthoracic and transesophageal echocardiography are uncertain, the multidetector computer tomography examination is an important complementary imaging method. Fluoroscopy is also an excellent tool for evaluating the mobility of prosthetic discs. Each method complements the other to differentiate an acute mechanical valve thrombosis from other prosthetic valve pathologies such as pannus formation or infective endocarditis and aids the physician in accurately establishing the treatment method (surgical or pharmaceutical) and its optimal timing. The aim of this pictorial review was to discuss from an imagistic perspective the mechanical prosthetic aortic and mitral valve thrombosis and to provide an overview of the essential role of non-invasive exploration in the treatment of this severe complication.

Prosthetic valve infective endocarditis with severe mitral stenosis caused by Cutibacterium acnes: a case report

“…Thrombi were larger, mostly extension into the left atrium, lower echo intensity than pannuses. 12 In this patient, the MV prosthesis had a flattened and thickened morphology, suggestive of a thrombus. Furthermore, the echoluminance was slightly elevated, indicating the presence of vegetation.…”

Chordae Tendinea Rupture and Pulmonary Valve Vegetation in Pediatric Endocarditis: A Rare Condition

“…Vegetations, or abnormal growths composed of fibrin, platelets, and microorganisms, are a hallmark of IE. While they most commonly affect the atrioventricular valves, the involvement of other valves, including the pulmonary valve, is less frequent [ 5 ]. Pulmonary valve vegetations are rare and may present unique diagnostic and therapeutic challenges, especially in pediatric patients where clinical suspicion may be low.…”