Hypo-attenuated leaflet thickening in surgically-implanted mitral bioprosthesis

Abstract

Background: Hypo-attenuated leaflet thickening (HALT) in bioprosthetic aortic valve has been studied, but its equivalent in bioprosthetic mitral valve (bMV) remains uncharacterized. We sought to identify the prevalence, hemodynamic characteristics, and significance of anticoagulation therapy in bMV HALT. Methods: A single-center cross-sectional study of 53 consecutive patients who underwent mitral valve replacement (MVR) with bMV between 2007 and 2017 was conducted. Cardiac-gated contrasted CT scans were obtained. Anticoagulant and antiplatelet therapy use were ascertained at the time of hospital discharge and CT scanning. Patient characteristics, postoperative stroke, and hemodynamic profile by echocardiogram were obtained to descriptively characterize the prevalence and characteristics associated with bMV HALT. Results: Three patients (5.7%) were found to have a HALT on bMV. The mean time from index MVR to CT scan was 3.4 ± 0.8 years in HALT cohort and 3.4 ± 2.7 years in non-HALT cohort. Fifty patients (94.3%) were discharged on warfarin, and 37 patients (69.8%) were on warfarin at the time of CT scans. One patient with HALT was on therapeutic warfarin at the time of the CT scan that identified HALT. All three patients were asymptomatic at the time of CT scan. In patients with HALT, mean transmitral pressure gradient were 8, 5, and 2.7 mmHg, all with trivial or mild mitral regurgitation. Conclusions: In this study, the prevalence of HALT was low at 5.7%, all presenting without symptoms. One patient presented with HALT while on therapeutic oral anticoagulation, which may suggest thrombotic etiology may not adequately explain HALT.

Trombose Tardia de Prótese Biológica em Posição Mitral com Apresentação com Obstrução Significativa e Insuficiência Cardíaca Aguda

“…4,5 Sua alta precisão também permite a detecção de TPVB subclínica, identificando o espessamento hipoatenuante dos folhetos, uma condição reconhecida principalmente após o implante de válvula aórtica transcateter, mas também relatada após a implantação cirúrgica de válvula mitral biológica. 6 O tratamento da TPVB depende da apresentação clínica, da repercussão hemodinâmica e da válvula acometida. Recomenda-se a anticoagulação com AVK ou heparina não fracionada antes de considerar uma nova intervenção.…”

“… 4 , 5 Sua alta precisão também permite a detecção de TPVB subclínica, identificando o espessamento hipoatenuante dos folhetos, uma condição reconhecida principalmente após o implante de válvula aórtica transcateter, mas também relatada após a implantação cirúrgica de válvula mitral biológica. 6 …”

“… 4 , 5 Its high accuracy also allows for the detection of subclinical BPVT by identifying hypoattenuated leaflet thickening, a condition mainly recognized after transcatheter aortic valve implantation, but also reported after a surgically-implanted biological mitral valve. 6 …”