Management of prosthetic mitral valve thrombosis

Abstract

Abstract. Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complications and outcome are limited. The purpose of this study was to review the clinical experience with the thrombolytic therapy and surgical management of prosthetic mitral valve obstruction in our hospital. Between the January 2001 and April 2005, twelve patients with obstructed prosthetic mitral valve were admitted to our hospital. There were 8 female and 4 male patients ranging in age from14 to 60 years, with a mean age of 34±12 years. In all patients, the diagnosis of prosthetic valve thrombosis was confirmed by echocardiography including transesophageal echocardiography. All patients showed absence or muffering of prosthetic valve sounds. Two of 12 patients received thrombolytic therapy by using streptokinase. In the remaining 10 patients, operations were performed on an emergency basis with median sternotomy and cardiopulmonary bypass techniques using antegrade-retrograde combinated isothermic blood cardioplegia and moderate hypothermia. The principal risk factors of prosthetic valve thrombosis are inadequate anticoagulation or fluctuation in anticoagulation levels. Its treatment is either surgical or with thrombolytics. Although both treatment methods are effective, the latter is gaining favor. However, surgery is often required due to large thrombi and a presence of pannus formation.

 

Keywords: Prosthetic mitral valve thrombosis, pannus, thrombolysis

Keywords

• Prosthetic mitral valve thrombosis, pannus, thrombolysis

Kaynakça

1. Edmunds LH. Thrombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg. 1987;44:430-445.
2. Deviri E, Sareli P, Wisenbaugh T, et al. Obstruction of mechanical valve prostheses: clinical aspects and surgical management. J. Am Coll Cardiol 1991;17:646-650.
3. Edmunds LH, Clark RE, Cohn LH, et al. Guidelines for reporting morbidity and mortality after cardiac valvular operations. J Thorac Cardiovasc Surg. 1996;112:708-711.
4. Vongpatanasin W, Hillis LD, Lange RA, et al. Prosthetic heart valves. N Engl J Med 1996;33:407-416.
5. Vitale N, Renzulli A, Cerasuolo F, et al. Prosthetic valve obstruction: Thrombolysis versus operation. Ann Thorac Surg 1994;57:365-370.
6. Kirklin J, Barrat Boyes B. Cardiac Surgery. New York: Churchill Livingstone; 1993.
7. Horstkotte D, Burckhardt D. Prosthetic valve thrombosis. J Heart Valve Dis 1995;4:141-153.
8. Silber H, Khan SS, Matloff JM, et al. The St. Jude valve. Thrombolysis as the first line of therapy for cardiac valve thrombosis. Circulation 1993;87:30- 37.

9. Kogon B, Kirshbom PH, Forbess JM, et al. Thrombolytic therapy for prosthetic valve thrombosis in children: Two case reports and review of the litareture. J Thorac Cardiovasc Surg. 2004;127:1519-1522.
10. Bollag L, Jost CHA, Vogt PR, et al. Symptomatic mechanical heart valve thrombosis: high morbidity and mortality despite successful treatment options. Swiss Med WKLY. 2001;131:109-116.
11. Roudaut R, Roques X, Lafitte S, et al. Surgery for prosthetic valve obstruction. A single center study of 136 patients. Eur J Cardio-Thorac Surg. 2003;24:868-872.
12. Dürrleman N, Pelerin M, Bouchard D, et al. Prosthetic valve thrombosis: Twenty-year experience at the Montreal Heart Institute. J Thorac Cardiovasc Surg 2004;127:1388-1392.
13. Rizzoli G, Guglielmi C, Toscano G, et al. Reoperations for acute prosthetic thrombosis and pannus: an assessment of rates, relationship and risk. Eur J Cardio-Thorac Surg 1999;16:74-80.
14. Czer LS, Weis M, Bateman TM, et al. Fibrinolytic therapy of St. Jude valve thrombosis under guidance of digital cinefluoroscopy. J Am Coll Cardiol 1985;5:1244-1249.
15. Gueret P, Vignon P, Fournier P, et al. Transesophageal echocardiography for the diagnosis and management of nonobstructive thrombosis of mechanical mitral valve prosthesis. Circulation. 1995;91:103-110.
16. Graver LM, Gelber PM, Tyras DH, et al. The risks and benefits of thrombolytic therapy in acute aortic and mitral prosthesis valve dysfunction: report of a case and review of the literature. Ann Thorac Surg 1988;46:85-88.
17. Kurzrok S, singh AK, Most AS, et al. Thrombolytic therapy for prosthetic cardiac valve thrombosis. J Am Coll Cardiol 1987;9:592-598.
18. Lengyel M, Fuster V, Keltai M, et al. Guidelines for management of left-sided prosthetic valve thombosis: a role for thrombolytic therapy. Consensus Conference on Prosthetic Valve Thrombosis. J Am Coll Cardiol. 1997;30:1521- 1526.
19. Shapira Y, Herz I, Vaturini M, et al. Thrombolysis is an effective and safe therapy in stuck bileaflet mitral valves in the absence of high-risk thrombi. J Am Coll Cardiol 200;35:1874-1880.
20. Vitale N, Renzulli A, Schinosa L, et al. Prosthetic valve obstruction :Thrombolysis versus operation (updated in 2000). Ann Thorac Surg 2000 ;70 :2182-2183.
21. Vitale N, Renzulli A, Agozzino A, et al. Obstruction of mechanical mitral prostheses: analysis of pathologic findings. Ann Thorac Surg 1997;63:1101-1106.
22. Hering D, Piper C and Horstkotte D. Management of prosthetic valve thrombosis. Eur Heart J 2001;3 (supplement Q);Q22-Q26.
23. Dieter RS, Dieter RA, Dieter RA, et al. Prosthetic heart valve thrombosis: An overview. Wisconsin Med J 2002;101:67-69.
24. Horstkotte D, Piper C, Schulte HD. Thrombosis of prosthetic heart valves: diagnosis and management. Zeitschrift fur Kardiologie. 1998;87 suppl 4:20-32.