Mechanical mitral valves without long-term anticoagulation up tothirteen years

Björk, V. O.; Ribeiro, Ary; Canetti, Mario

doi:10.1016/s0022-5223(99)70036-x

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…Bjork et al 16,17 postulated that all thromboembolic complications in mechanical heart valves start from a thrombus lining that covers the suture ring. The thrombus organizes to a fibrous white sheet over the suture ring, which then can protrude out over the polished surface of the valve ring flange.…”

Section: Discussionmentioning

confidence: 99%

Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

Salmane

Pandya

Lafferty

et al. 2016

Clin Med Insights Cardiol

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A male patient in his early 90s with a past medical history of hypertension and dyslipidemia and a surgical history of prosthetic (mechanical) aortic valve replacement (AVR) performed 27 years ago (1988) for aortic stenosis presented to our hospital with a chief medical complaint of fatigue, weakness, and chills for a duration of one day. His medications at home included clopidogrel, chlorthalidone, valsartan, and metoprolol. He had discontinued taking warfarin a few weeks after being discharged from his valve replacement surgery because of excessive bruising. His primary care doctor later started him on clopidogrel in 2001.His initial vitals in the emergency department were stable, except for a low-grade temperature of 100.4 °F. The physical examination revealed dry mucous membranes and a grade 3/6 systolic murmur, and metallic aortic valve opening and closing clicks at the aortic area along with a grade 2/6 systolic murmur at the apex. His electrocardiography revealed a normal sinus rhythm with signs of chamber enlargements. Chest X-ray revealed enlarged cardiac silhouette and the presence of heart valve prosthesis. Initial blood tests included total biochemistry, complete blood count, prothrombin time, partial thromboplastin time, fibrinogen, and thyroid function tests. All were unremarkable, except for creatinine of 2.30 and BUN of 51. A functional aortic prosthetic (metallic) valve with a maximum/mean gradient of 72/39 mmHg was verified with transthoracic echocardiography. In addition, a mildly elevated pulmonary artery pressure of 40 mmHg and a left ventricular ejection fraction of 55-65% were estimated; there was no evidence of thrombus or pannus formation.The patient was admitted with a diagnosis of acute kidney injury secondary to dehydration, and he was successfully treated with intravenous (IV) hydration. After educating the patient about the consequences of thrombosis and thromboembolism (TE) in patients with metallic heart valves, he was immediately bridged with IV heparin onto oral warfarin, with which he was discharged on. His international normalized ratio (INR) at discharge was in the therapeutic range at 2.6. Case 2The second case is a male patient in his 60s with a past medical history of chronic hepatitis C and rheumatic aortic valve disease and a surgical history of prosthetic AVR performed 37 years ago for aortic valve incompetence. He underwent AVR with Braunwald-Cutter prosthesis at 22 years of age. The aortic valve was replaced again five years later with a Björk-Shiley (B-S) valve due to fractures of the valve's outlet AbstrACt: Sixty percent of the patients going for valve replacement opt for mechanical valves and the remaining 40% choose bioprosthetics. Mechanical valves are known to have a higher risk of thrombosis; this risk further varies depending on the type of valve, its position, and certain individual factors. According to current guidelines, long-term anticoagulation is indicated in patients with metallic prosthetic valve disease. We report two unique cases of patients who s...

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Section: Discussionmentioning

confidence: 99%

Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

Salmane

Pandya

Lafferty

et al. 2016

Clin Med Insights Cardiol

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“…Activation of platelet aggregation and the coagulation cascade has been noted in the early postoperative period by the raw intracardiac surfaces, sewing ring and suture knots. Bjork et al [3] postulated that it may require at least 3 months for these raw surfaces to be endothelialised so that anticoagulation may not be required 3 months after valve replacement. 12 patients with mechanical mitral valve replacement were followed for a period of 13 years.…”

Section: Discussionmentioning

confidence: 99%

Normally Functioning Tilting Disc Mechanical Mitral and Aortic Valve Prosthesis without Anticoagulant Therapy - An Unusual Case

Husain¹,

Rawat²,

Yadav³

2016

IOSR

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“…Most of the reported cases involved an aortic metallic valve and it is well known that a prosthetic aortic valve has much better chances of survival without embolic events than the mitral valve. 2 To the best of our knowledge, there are 6 cases of aortic, 3–8 2 cases of mitral, 9–10 and 1 case of tricuspid prosthetic valve 11 without embolic episodes who were not under anticoagulation treatment in the literature (Table 1 ). The protection of these valves thus far has been reported as unknown and the potential factors underlying the normal valvular mechanics in these patients are still unknown.…”

Section: Discussionmentioning

confidence: 99%

“The End of Good Luck’’—Long-Term Survival Without Anticoagulation

Gül

Altunbaş

Kayrak

et al. 2011

Clin Appl Thromb Hemost

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Long-term anticoagulation in patients with metallic prosthetic valve disease is required according to current guidelines. We describe a patient with a functioning mitral mechanical valve without anticoagulation for 27 years. A 46-year-old man admitted to the emergency department with complains of palpitation. The patient had a mitral valve replacement because of severe mitral stenosis. He discontinued warfarin treatment 1 month after surgery because of the unavailability of this drug in Turkey. Transthoracic echocardiography revealed functioning metalic mitral valve with a mean gradient of 9 mm Hg. Fluoroscopy showed normal excursions of the mechanical mitral valve. Transesophageal echocardiography was performed and revealed fresh thrombus formation in the left atrial appendix. Admission international normalized ration (INR) level was 1.79. Due to the higher INR level and long-term survival, genetic analysis of warfarin polymorphism was performed. There was a homozygous mutation in the vitamin K epoxide reductase complex 1 (VKORC1) 1173C>T and 1639G>A genotypes. The possible explanations of long-term survival and baseline higher INR level were linked to the mutation in warfarin metabolism. We also briefly review the literature.

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Mechanical mitral valves without long-term anticoagulation up tothirteen years

Abstract: Letters to the Editor 769 Fig 1. Clotted blood was seen in the whole LVAS motor chamber, which prevented the pump from working.

Cited by 5 publications

References 4 publications

Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

Longest Event-Free Survival without Anticoagulation in a Mechanical Aortic Valve Replacement

Normally Functioning Tilting Disc Mechanical Mitral and Aortic Valve Prosthesis without Anticoagulant Therapy - An Unusual Case

“The End of Good Luck’’—Long-Term Survival Without Anticoagulation

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