Prosthetic heart valve thrombosis: Diagnosis and newer thrombolytic regimes

Krishnan, Shanmugam

doi:10.4103/2395-5414.182993

Cited by 9 publications

(5 citation statements)

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“…Till date, there has been no class I recommendation in any guideline for management of PHVT due to no randomized controlled trials. 5 In India, the exact rate of incidences of PHVT and its primary treatment preference has been lacking. The choice of the therapeutic modality for treatment of PHVT (heparin treatment, thrombolysis, surgery) has been largely influenced by the presence of valvular obstruction, by valve location (left-or right-sided), and by clinical status.…”

Section: Introductionmentioning

confidence: 99%

Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

Patil¹,

Setty²,

Ramalingam³

et al. 2019

Int J Res Med Sci

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Background: The study aimed to evaluate the clinical presentation, diagnostic features, treatment strategies, and complications of prosthetic heart valve thrombosis (PHVT) and to determine efficacy, outcomes and complications of thrombolytic therapy during hospital stay.Methods: This was a prospective, observational, single-centre study carried out between March, 2016 and December, 2017 at a tertiary care centre in India. Total 110 patients with history of prosthetic heart valve replacement and symptoms related to PHVT were included in the study. Patients underwent thrombolysis, surgery or conservative management for treatment of PHVT, as per their individual clinical presentation. Clinical profile and treatment outcomes were assessed using a pre-tested, semi-structured questionnaire and clinical assessment.Results: Mean age of the patients was 39.4±12.5 years. Most of the patients presented with NYHA class II and III (85.4%) symptoms. Total 20.9% of patients were poorly compliant with anticoagulants. Thrombolysis was initial treatment in 105 (95.5%) patients. Five (4.6%) patients were treated with heparin. Two patients underwent surgery after failed thrombolysis. Mortality in the thrombolysis group was 6.6%. Embolism occurred in 8.6% of the group and major bleeding in 1.9%. One patient who underwent surgery died.Conclusions: In light of these results, it can be concluded that most cases of PHVT are due to inadequate anticoagulation and poor monitoring mainly in patients belonging to the lower socioeconomic group. Thrombolysis can be considered as first line therapy where the immediate surgical options are remote.

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Section: Introductionmentioning

confidence: 99%

Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

Patil¹,

Setty²,

Ramalingam³

et al. 2019

Int J Res Med Sci

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“…There is a high prevalence of rheumatic heart disease in young in India and the majority undergo valve replacement surgery at a young age compared to developed countries [9,10]. The mean age of our patients was 46.62±13.6.most of the studies from the Indian continent of PVT belonging to younger age group in 3rd and 4th decade and female dominance [11][12][13][14][15]. Mean age was 58±12 in a study from Montreal [16].…”

Section: Discussionmentioning

confidence: 96%

"Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study"

Asotra¹

2021

ACR

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Introduction: Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The present study aims to evaluate patients with prosthetic valve thrombosis in terms of the clinical characteristics, risk determinants, treatment, and outcomes in the prospective observational study. Material and Methods:The observational study was conducted in a tertiary care center. All patients suspected of having prosthetic valve dysfunction underwent clinical, echocardiography, and fluoroscopic examination. Data regarding risk determinants, clinical characteristics, and response to treatment was categorized on the basis of serial echocardiography and fluoroscopy into 3 classes; complete response, partial response, and failed treatment.Result: Out of 29 patients 17 (59%) were females and 12 (41%) were males. The mean age was 46.6years with an age range from 20-80 years. 15 (52%) patients were post MVR, 9 (32%), post DVR and 5 (17%) were post AVR. Dyspnoea was the presenting complaint in all the patients presenting with valve thrombosis. Mitral valve thrombosis was seen in 19 (65%), aortic valve thrombosis in 8 (28%), and tricuspid valve thrombosis in 2 (7%). 86% of patients had sub-therapeutic INR. Intensification of anticoagulation and thrombolytic therapy was the treatment modalities deployed.76% of patients received thrombolytic therapy and streptokinase was the most common agent used in 82% of patients. Majority of patients presented with symptoms of NYHA class III. 62% of patients showed complete response, 24% of patients showed partial response, and 4 (14%) had no response to lytic therapy. 7 out of 29 patients landed up in complications. 4 out of 29 patients had minor bleeds in the form of oral mucosal ooze and haematuria. 3 patients succumbed to complications, one of whom had a major bleed in the form of intracranial hemorrhage and two had worsening of heart failure. Conclusion:The most important risk factor attributed to the occurrence of prosthetic valve thrombosis was non-compliance to treatment leading to subtherapeutic INR. Mitral valve thrombosis was most commonly seen and Fibrinolysis can be considered as effective therapy even in patients presenting with NYHA Class III/IV especially in resource-stricken developing countries.

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“…Emergency surgery is recommended for a thrombosed leftsided prosthetic heart valve with class III-IV symptoms. Surgery is also recommended with a large thrombus (>0.8 cm2) (18). PHVT may be suspected if the Doppler-derived gradients are twice as high as empirically found in normal prostheses.…”

Section: Recommendationsmentioning

confidence: 99%

“…For mitral prostheses, a mean gradient >6 mmHg and an effective area <1.3 cm 2 is suggestive of PHVT and >8 mmHg is indicative of PHVT. 18 Castilho et al conducted a meta-analysis which included all studies comparing thrombolysis and surgery found that mortality was significantly lower in thrombolysis arm than surgery arm (6.6% versus 18.1%). 19 Retrospective international registry including 107 patients with prosthetic heart valve thrombosis found an association between thrombus area >0.8 cm 2 and thrombolytic therapy failure or adverse events.…”

Section: Recommendationsmentioning

confidence: 99%

Thrombolytic therapy as first line treatment in prosthetic mitral valve thrombosis

et al. 2023

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Background: A very common post-operative mechanical complication of a prosthetic valve is thrombosis leading to valve being stuck. This leads to rapid development of heart failure and can result in sudden death of the patient in an aggravated manner. The study aims to put forth the importance of immediate thrombolysis in such patients which can provide bridging between the event and immediate surgery. Methods: A total of 50 patients were retrospectively studied after presentation with prosthetic valve thrombosis and the thrombolytic agent used in all the cases was injectable streptokinase or urokinase. Post streptokinase patients were given heparin infusion and oral anticoagulants. The therapy was considered failure if transvalvular gradients decreased less than 50% or in case of persistent valve motion abnormality. Results: 94% patients had complete normalisation of valve function and decrease in transvalvular gradients to less than 50% within the first 24 hours. 4% patients required surgery and 2% patients could not survive the treatment. Conclusions: Immediate thrombolysis on presentation has shown significant improvement in survival without the risk of subjecting patients to redo surgeries which are associated with multiple complications in the perioperative period.

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Prosthetic heart valve thrombosis: Diagnosis and newer thrombolytic regimes

Cited by 9 publications

References 1 publication

Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

Study of prosthetic heart valve thrombosis and outcomes after thrombolysis

"Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study"

Thrombolytic therapy as first line treatment in prosthetic mitral valve thrombosis

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