Prosthetic valve thrombosis: predisposition and diagnosis

Piper, Cornelia; Hering, Detlef; Horstkotte, Dieter

doi:10.1016/s1520-765x(01)90037-9

Cited by 21 publications

(20 citation statements)

References 12 publications

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“…The third major reason for thrombosis comprises clot promoting factors including inadequate coagulation, atrial fibrillation, incomplete endothelialisation of the valve sewing ring, and inflammation, often with a raised fibrinogen level. [13] Our patient denied any recent infection or disease causing any systemic inflammation and she was in sinus rhythm. She had not consumed any drug.…”

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confidence: 79%

“…[12] Three basic mechanisms have been defined -firstly, adsorption of plasma proteins, including fibrinogen, onto the surface of the valve prosthesis leads to platelet adhesion and induction of the coagulation cascade. [13] The second factor is the effect of transprosthetic blood flow -'turbulent' flow due to unphysiological flow that is rapidly changing directions, increases the blood borne shear stress to more than 10 dynes/sq.cm. causing metabolic and structural damage to the endocardium which is prone to further thrombosis.…”

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confidence: 99%

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Mitral Mechanical Prosthetic Valve Thrombosis Four Years After Discontinuing Anticoagulation: A Case Report

Chitrapu¹,

Rao²,

D³

et al. 2015

jemds

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A 40 years lady who underwent a mitral valve replacement with a mechancial prosthesis nine years ago, stopped oral anticoagulants totally. She was asymptomatic and doing her field job with good exercise tolerance for 4 years without any anticoagulation or follow-up and presented now with acute pulmonary edema due to prosthetic valve thrombosis. Echocardiography revealed a large clot on the mitral valve and increased Doppler gradients across the valve. She was given intravenous streptokinase for 28 hours with relief of symptoms, re-appearance of prosthetic valve click and normalisation of flow velocities. She was prescribed oral acenocoumarol and discharged in a stable condition. CASE:Mrs. N, a 40 years lady was admitted with a two day history of Class IV dyspnea and was diagnosed to have mitral prosthetic valve thrombosis. She had undergone mitral valve replacement with a 27mm Medtronic Hall prosthesis for severe rheumatic mitral regurgitation in 2005; a permanent pacemaker was implanted when she developed complete heart block postoperatively. She was put on acenocoumarol and was on follow-up until 2011with an INR between 2 and 2.5. She discontinued oral anticoagulants and all drugs from August 2011 but reported no complaints -she had fair exercise tolerance and worked as a health worker which entailed field visits. She noticed mild dyspnea, but continued her work for the past 3 weeks, and was admitted now with acute pulmonary edema. The prosthetic valve click was muffled and the ECG showed a paced rhythm. Echocardiogram revealed decreased mobility of the mitral prosthesis with a large clot attached to it. The mitral flow gradients were very much increased with a peak gradient of 60 mm.Hg. And a mean gradient of 40 mm. Hg. She also had moderate aortic regurgitation and pulmonary hypertension with tricuspid regurgitation. The ejection fraction was 61.A diagnosis of prosthetic valve thrombosis was made and she was given intravenous streptokinase -2.5 lakh units as an intravenous bolus followed by an infusion of 1 lakh units per hour (for 28 hours). She was administered IV frusemide and sedation on admission in the ICCU. Acenocoumarol was also started at a dose of 2mg daily. By next day morning, she was better, the mitral valve click was well heard and echocardiography revealed a well-functioning mitral prosthesis with acceptable flow gradient -a peak of 8 and a mean of 3. Thrombus was not visible. She was administered enoxaparin 0.6mg bid for 5 days for the oral anticoagulant to take effect. The patient was discharged, in an asymptomatic condiction, and with fair effort tolerance, after 9 days, on acenocoumarol 2mg. daily and aspirin 75 mg.

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confidence: 79%

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confidence: 99%

Mitral Mechanical Prosthetic Valve Thrombosis Four Years After Discontinuing Anticoagulation: A Case Report

Chitrapu¹,

Rao²,

D³

et al. 2015

jemds

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“…Prosthetic valve thrombosis is a rare but potentially life threatening complication after valve replacement [1,2]. Its management includes thrombolytic treatment, surgery or heparin.…”

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confidence: 99%

A Rare Cause of Myocardial Infarction: Acute Inferoposterior Myocardial Infarction After Successful Intravenous Thrombolytic Treatment of Mechanical Mitral Prosthetic Valve Thrombosis

Altınbaş

Küçüktepe

Özaydın

et al. 2005

Int J Cardiovasc Imaging

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Prosthetic valve thrombosis is a rare and dreaded complication of patients with mechanical valves, particularly those in the mitral position. A 45-year-old female with status post prosthetic mitral valve replacement was admitted to the hospital with acute pulmonary edema. Echocardiography showed mitral valve thrombosis which was treated with tissue plasminogen activator (t-PA). During t-PA infusion she developed acute inferoposterior myocardial infarction. Coronary angiography showed normal coronary arteries. Presented case had acute inferoposterior myocardial infarction secondary to coronary emboli after the successful thrombolytic treatment of prosthetic mitral valve thrombosis.

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“…The incidence of PHV has decreased over the years, but still ranges from 0.1 to over 6% per patient-year. 1 In pregnant patients with a PHV, anticoagulation is associated with embryopathy, abortion and maternal bleeding complications during delivery. 2 The optimal anticoagulation strategy during pregnancy is controversial and a matter of debate.…”

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confidence: 99%

Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

Kuilenburg¹,

Verheugt²,

Dijk³

2007

NHJL

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In pregnant patients with a prosthetic heart valve (PHV), anticoagulation with warfarin is associated with embryopathy, foetal loss early in pregnancy and maternal bleeding complications in the delivery period. The optimal anticoagulation strategy in the pre-pregnancy period and during pregnancy itself is controversial and a matter of debate. We describe a patient with PHV in the pre-pregnancy period and in a subsequent pregnancy. The optimal anticoagulation treatment strategy in women in their reproductive years with mechanical valve thrombosis is discussed. (Neth Heart J 2007;15: 306-9).

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Prosthetic valve thrombosis: predisposition and diagnosis

Cited by 21 publications

References 12 publications

Mitral Mechanical Prosthetic Valve Thrombosis Four Years After Discontinuing Anticoagulation: A Case Report

Mitral Mechanical Prosthetic Valve Thrombosis Four Years After Discontinuing Anticoagulation: A Case Report

A Rare Cause of Myocardial Infarction: Acute Inferoposterior Myocardial Infarction After Successful Intravenous Thrombolytic Treatment of Mechanical Mitral Prosthetic Valve Thrombosis

Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature

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