Obstruction of the St. Jude Medical Valve - Diagnostic and Therapeutic Values of Cineradiography

Abstract

Between 1984, and 1992, we observed 8 patients with an obstructed St. Jude Medical (SJM) valve. Of these, 1 had an obstructed SJM valve in the aortic position, 3 in the mitral position, and 4 in the tricuspid position. Diagnosis of obstruction of the SJM valve was made by cineradiography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed by cineradiography in all of the 8 patients. Normal range of leaflet mobility of the SJM valve was measured by conventional cineradiography in 70 patients with a normal SJM valve, and the results were compared with the leaflet mobility obtained from the 8 patients with an obstructed SJM valve. In this study, leaflet function in the obstructed SJM valve was strikingly abnormal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 underwent urgent prosthetic valve replacements after cineradiography and echocardiography were carried out. Thrombolysis using urokinase was performed in 4 patients, and this treatment was successful in 1 patient. Efficacy of thrombolytic therapy was evaluated by repeat cineradiography. Three of the 4 patients who received thrombolysis showed no significant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that cineradiography combined with echocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function.(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.…”

“…[17][18][19][20][21][22][23] Since the introduction of TEE, ultrasound imaging has become the most used test in case of prosthesis dysfunction. This change happened without convincing scientific evidence of the superiority of 1 technique over the other.…”

Thrombolytic Therapy with Tissue Plasminogen Activator for the Treatment of Nonstructural Malfunction of Bileaflet Cardiac Valve Prostheses

“…On the other hand, successful thrombolytic therapy was first described by Luluaga and colleagues (17) in a patient with obstructed prosthetic valve in the tricuspid position. Since then, the efficacy of thrombolytic therapy with either streptokinase, urokinase, or heparin has been demonstrated (5,14,16,18,19). A report (16) that summarized over two hundred published reports that investigated left‐sided prosthetic valve thrombolytic therapy indicated an initial success rate of 82%, an overall thromboembolism rate of 12%, stroke rate of 5% to 10%, mortality rate of 6%, major bleeding complication rate of 5%, and recurrent thrombosis rate of 11%.…”

“…Accordingly, early diagnosis and treatment with t‐PA are essential for the management of patients with prosthetic valve malfunction. The combination of Doppler echocardiography and cineradiography should be used for the diagnosis so as not to overlook prosthetic valve malfunction especially when the patients are asymptomatic (5,10).…”

“…SJM: St. Jude Medical valve, Aortic: valve was implanted in aortic position, Pre t-PA: preadministration of t-PA, Post t-PA: the end period of treatment. nase, urokinase, or heparin has been demonstrated (5,14,16,18,19). A report (16) that summarized over two hundred published reports that investigated leftsided prosthetic valve thrombolytic therapy indicated an initial success rate of 82%, an overall thromboembolism rate of 12%, stroke rate of 5% to 10%, mortality rate of 6%, major bleeding complication rate of 5%, and recurrent thrombosis rate of 11%.…”