Obstruction of mechanical heart valve prostheses: Clinical aspects and surgical management

Abstract

One hundred patients (32 male) aged 5 months to 82 years (median 32 years) underwent 106 surgical procedures for 112 mechanical prosthetic valves obstructed by a thrombus (n = 61) or pannus (n = 7), or both (n = 44), between January 1, 1980 and December 31, 1989. The position of the obstructed prosthesis was aortic in 51 patients (48%), mitral in 49 (46%) and both aortic and mitral in 6 (6%). The types of obstructed prosthetic valves were Björk-Shiley (n = 51), St. Jude (n = 41) and Medtronic-Hall (n = 20). The time interval between valve replacement and obstruction ranged from 6 weeks to 13 years (median 4 years). Of 63% of patients in whom coagulation variables were available at the time of obstruction, 70% were receiving inadequate anticoagulant therapy. In 63% of the procedures the patient was in New York Heart Association functional class IV. Two patients underwent preoperative thrombolysis with incomplete results. Operative procedures included valve replacement (n = 81), valve declotting and excision of pannus (n = 23) and aortic valve replacement and mitral valve declotting (n = 2). The early mortality rate was 12.3% (13 patients), and there was no difference between surgery for mitral prostheses (12.2%) versus aortic prostheses (13.7%). The perioperative mortality rate was 17.5% (11 of 63 patients) in patients in functional class IV and 4.7% (2 of 43 patients) in those in functional classes I to III (p less than 0.05). For valve replacement, the mortality rate was 12% (10 of 81 patients) and for declotting of the prosthesis 13% (3 of 23 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] It decreased to 5Ϯ3 mmHg (Pϭ. 000) soon after T and to 4Ϯ2 mmHg (Pϭ0.000 versus baseline, PϭNS versus end of T infusion) at 24 hours.…”

“…Actually, the detection of a normal motion of the other leaflet could be in favor of pannus rather than thrombosis. In fact, if thrombosis were the cause of valve dysfunction, since it is usually located at the valve hinge area in bileaflet prostheses, 3 it would have affected both leaflets motion. Thus, F evidence of single blocked disc in late PVT should raise the suspicion of pannus formation.…”

“…[1][2][3] Surgical intervention has been the traditional way to treat PVT. However, reported operative mortality may be as high as 69%, largely depending on patient functional class.…”

Treatment of mechanical valve thrombosis during pregnancy

“…For patients presenting with New York Heart Association (NYHA) functional class I through III and IV, the surgical mortality rates are 4.7% and 17.5%, respectively. 7 On recent meta-analysis, the overall clinical success rate for left-sided MVT treated with thrombolysis was reported as 72%. 8 Clinical success was defined as resolution of thrombus and/or valvular obstruction indicated by increased leaflet movement to 90% of normal or clinical improvement without major complications.…”

Multivariate Analysis for Operative Mortality in Obstructive Prosthetic Valve Dysfunction Due to Pannus and Thrombus Formation

“…1) Obstructive PVD has other causes, such as patient-valve mismatch or failure of hemodynamic performance, particularly in first generation mechanical valves. A lack of cooperation between the patient and cardiologist based on information is the main factor in PVD all over the world.…”