Complete Prosthetic Valve Thrombosis Despite Several Thrombolytic Treatments after Tricuspid Valve Replacement

1993 ◽  
Vol 41 (03) ◽  
pp. 199-201 ◽  
Author(s):  
M. Cottogni ◽  
H. Antretter ◽  
W. Furtwängler
Keyword(s):  
Valve Replacement ◽  
Tricuspid Valve ◽  
Prosthetic Valve ◽  
Tricuspid Valve Replacement ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis

scholarly journals Thrombolytic therapy in prosthetic valve thrombosis in the second trimester of pregnancy

2020 ◽  
Vol 7 (5) ◽  
pp. 853
Author(s):  
Santhosh Jadhav ◽  
H. S. Natraj Setty ◽  
Shankar S. ◽  
Phani Teja Mundru ◽  
Yeriswamy M. C. ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Mechanical Valve ◽  
Second Trimester ◽  
Prosthetic Valve Thrombosis ◽  
First Line Therapy ◽  
Mechanical Valves ◽  
Valve Thrombosis

Pregnancy with mechanical valves requires anticoagulation, the risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected. Prosthetic valve thrombosis during pregnancy requires immediate therapy such as valve replacement, thrombolytic therapy, or surgical thrombectomy. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. We describe a primigravida (second trimester) with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.

scholarly journals Modified fibrinolytic therapy as treatment of mechanical aortic valve thrombosis

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199920
Author(s):  
Ala Mustafa ◽  
Todd Thomas ◽  
Robert Murdock ◽  
Samuel Congello
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Treatment Options ◽  
Fibrinolytic Therapy ◽  
Current Management ◽  
Prosthetic Valve Thrombosis ◽  
Mechanical Aortic Valve ◽  
Valve Thrombosis ◽  
Surgical Valve Replacement

Prosthetic valve thrombosis is a rare phenomenon with limited treatment options. Current management choices include anticoagulation with or without fibrinolysis or surgical valve replacement for appropriate candidates. We report an alternative fibrinolytic and anticoagulation regimen resulting in successful treatment of a patient presenting with mechanical aortic valve thrombosis.

scholarly journals Tricuspid Valve Infective Endocarditis In Drug Abusers: Clinical Features and Results of Surgical Treatment

2013 ◽  
Vol 7 (1) ◽  
pp. 29-34
Author(s):  
DI Lashmanov ◽  
Krishna Bhandari ◽  
VA Chiginev ◽  
VV Pichugin ◽  
EN Zemskova
Keyword(s):  
Surgical Treatment ◽  
Drug Abuse ◽  
Infective Endocarditis ◽  
Valve Replacement ◽  
Clinical Features ◽  
Tricuspid Valve ◽  
Prosthetic Valve ◽  
Drug Abusers ◽  
Tricuspid Valve Replacement ◽  
Ultrasound Investigation

The objective of this study was to evaluate the clinical features, diagnostic criteria and indications for surgery in patients – drug abusers with tricuspid valve infective endocarditis (TVIE), and outcome of surgical treatment in these patients. From December 1999 to August 2009 35 patients (drug addicts) with TVIE were operated in the department of acquired heart diseases of Cardiac and Vascular Surgery Center, Nizhny Novgorod. 25 males and 10 females aged from 15 to 51 years were included in this study. 3 patients were re-operated due to recurrence of endocarditis. Biological prosthetic valve "Bio-Lab" was used in all patients. Intravenous drug abuse was the cause of the disease in all patients. Acute onset with hectic fever, shivering, profuse sweating, intoxication and development of multi-organ failure were the main clinical features of the disease. Embolism of the peripheral branches of pulmonary artery by septic embolus or micro thrombi were common symptoms. Ultrasound investigation played an important role in diagnosis of TVIE. It was the only criteria for the verification of the diagnosis in patients with fever of unknown origin until the appearance of valve damages and cardiac murmurs. All 35 (100%) patients underwent tricuspid valve replacement (TVR). 3 (8.57%) patients underwent redo TVR because of prosthetic valve endocarditis due to persistent intravenous drug abuse after surgery. The hospital mortality rate was 0%. Acute debut of the disease may be the first clinical feature of tricuspid valve infec­tive endocarditis in drug abusers. Ultrasound investigation is important for early diagnosis and effective treatment. Surgical treatment is indicated in cases of ineffective antibiotic therapy and massive tricuspid valve damages. Tricuspid valve replacement by a biological prosthesis was the treatment of choice in these patients. The use of biological prosthetic valve had good clinical re­sults with low thrombogenic risk and high resistance to infection. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 29-34 DOI: http://dx.doi.org/10.3126/njh.v7i1.8499

scholarly journals Maternal and Fetal Outcomes in Pregnant Women with a Prosthetic Mechanical Heart Valve

2016 ◽  
Vol 10 ◽  
pp. CMC.S36740 ◽  
Author(s):  
Sherif W. Ayad ◽  
Mahmoud M. Hassanein ◽  
Elsayed A. Mohamed ◽  
Ahmed M. Gohar
Keyword(s):  
Heart Failure ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
First Trimester ◽  
Fetal Outcomes ◽  
Prosthetic Valve Thrombosis ◽  
Daily Dose ◽  
Valve Thrombosis ◽  
Fetal Complications ◽  
Valve Prostheses

Background Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. These changes include an increase in cardiac output, sodium, and water retention leading to blood volume expansion, and reductions in systemic vascular resistance and systemic blood pressure. In addition, pregnancy results in a hypercoagulable state that increases the risk of thromboembolic complications. Objectives The aim of this study is to assess the maternal and fetal outcomes of pregnant women with mechanical prosthetic heart valves (PHVs). Methods This is a prospective observational study that included 100 pregnant patients with cardiac mechanical valve prostheses on anticoagulant therapy. The main maternal outcomes included thromboembolic or hemorrhagic complications, prosthetic valve thrombosis, and acute decompensated heart failure. Fetal outcomes included miscarriage, fetal death, live birth, small-for-gestational age, and warfarin embryopathy. The relationship between the following were observed: – Maternal and fetal complications and the site of the replaced valve (mitral, aortic, or double) – Maternal and fetal complications and warfarin dosage (≤5 mg, >5 mg) – Maternal and fetal complications and the type of anticoagulation administered during the first trimester Results This study included 60 patients (60%) with mitral valve replacement (MVR), 22 patients (22%) with aortic valve replacement (AVR), and 18 patients (18%) with double valve replacement (DVR). A total of 65 patients (65%) received >5 mg of oral anticoagulant (warfarin), 33 patients (33%) received ≤5 mg of warfarin, and 2 patients (2%) received low-molecular-weight heparin (LMWH; enoxaparin sodium) throughout the pregnancy. A total of 17 patients (17%) received oral anticoagulant (warfarin) during the first trimester: 9 patients received a daily warfarin dose of >5 mg while the remaining 8 patients received a daily dose of ≤5 mg. Twenty-eight patients (28%) received subcutaneous (SC) heparin calcium and 53 patients (53%) received SC LMWH (enoxaparin sodium). Prosthetic valve thrombosis occurred more frequently in patients with MVR ( P = 0.008). Postpartum hemorrhage was more common in patients with aortic valve prostheses than in patients with mitral valve prostheses ( P 0.005). The incidence of perinatal death was higher in patients with AVR ( P 0.014). The incidence of live birth was higher in patients with DVR ( P 0.012). The incidence of postpartum hemorrhage was higher in patients who received a daily dose of >5 mg of warfarin than in patients who received ≤5 mg of warfarin ( P 0.05). The incidence of spontaneous abortion was also higher in patients receiving >5 mg of warfarin (P ≤ 0.001), while the incidence of live births was higher in patients receiving ≤5 mg of warfarin ( P 0.008). There was a statistically significant difference between the anticoagulant received during the first trimester and cardiac outcomes. Specifically, patients on heparin developed more heart failure ( P 0.008), arrhythmias ( P 0.008), and endocarditis ( P 0.016). There was a statistically significant relationship between heparin shifts during the first trimester and spontaneous abortion ( P 0.003). Conclusion Warfarin use during the first trimester is safer for the mother but is associated with more fetal loss, especially in doses that exceed 5 mg. The incidence of maternal complications is greater in women who receive LMWH or unfractionated heparin during the first trimester, especially prosthetic valve thrombosis, although the fetal outcome is better because heparin does not cross the placenta.

scholarly journals Tricuspid Valve Replacement: Mechanical or Biological Prostheses? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 24 (2) ◽  
pp. E209-E214
Author(s):  
Zeyi Cheng ◽  
Tingting Fang ◽  
Dandan Wang ◽  
Yingqiang Guo
Keyword(s):  
Valve Replacement ◽  
Tricuspid Valve ◽  
Prosthetic Valve ◽  
Meta Analysis ◽  
Early Mortality ◽  
Tricuspid Valve Replacement ◽  
Mechanical Prostheses ◽  
Significant Difference ◽  
Valve Position ◽  
Biological Prostheses

Background: Tricuspid valve replacement (TVR) is seldom performed in cardiac valve surgery, and there currently are no clinical guidelines as to which type of prostheses is better in tricuspid valve position. This meta-analysis was performed to compare the results of mechanical and biological prostheses for TVR. Methods: We searched the Pubmed, Cochrane, and Embase clinical trial databases to collect all related studies published from January 1, 2000 to July 31, 2020. A random-effects model was used to evaluate the odds ratios (OR) and its 95% confidence intervals (CI) of time-to-event related effects of the surgical procedures; every study’s quality was evaluated by the Newcastle-Ottawa Scale (NOS). Results: A total of 13 retrospective studies, including 1453 patients were analyzed. There were no statistically differences between mechanical and biological prostheses with respect to prosthetic valve failure [OR = 0.84, 95% CI(0.54, 1.28), P = .41], bleeding [OR = 0.84, 95% CI(0.54,1.28), P = .41], reoperation [OR = 1.02, 95% CI(0.58,1.78), P = .95], early mortality [OR = 1.35, 95% CI(0.82,2.25), P = .24] and long-time survival [OR = 1.09, 95% CI(0.70, 1.69), P = .70], but a significant difference can be seen in mechanical prostheses with a higher risk of thrombosis [OR = 0.17, 95% CI(0.05, 0.60), P = .006, I2 = 0%]. Conclusions: In tricuspid valve position, mechanical valve prostheses have a higher risk of thrombosis than biological prostheses, but no statistical differences between mechanical and biological prostheses with respect to prosthetic valve failure, bleeding, reoperation, early mortality, and long-term survival. The valve disease and patient’s age and risk factors are the most important considerations in the decision-making process. The more specific conclusion needs to be further proved by large-sample, multi-center, randomized, double-blind and control trials.

RESULT OF SLOW INFUSION OF STREPTOKINASE THERAPY IN LEFT SIDED PROSTHETIC VALVE THROMBOTIC OCCLUSION- A CASE SERIES FROM A TERTIARY CARE HOSPITAL IN EASTERN INDIA

2021 ◽  
pp. 14-16
Author(s):  
Saroj Mandal ◽  
Suvendu Chatterjee ◽  
Kaushik Banerjee ◽  
Sidnath Singh
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Thrombolytic Therapy ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Minor Bleeding ◽  
Care Hospital ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
Slow Infusion

Prosthetic valve thrombosis (PVT) is a life threatening complication seen after heart valve replacement and is associated with high mortality and morbidity. Surgical approach or brinolysis and heparin therapy are considered as treatments of choice according to the clinical status of the patient. Thrombolytic therapy has been tried in cases with acute prosthetic valve thrombosis as an alternative to emergency operation with variable results. But fear of peripheral embolism has limited its use in left-sided valve occlusions. The incidence of complications decreases with low dose and slow infusion of brinolytic therapy. In this study we are presenting our experience of thrombolytic therapy with streptokinase in 40 patients who had presented with acute or subacute left-sided prosthetic valve thrombosis. In this study the mean age was 40.9 years (SD-11.2, range-19 to 64 year) with majority (77.5%) were below 50 year of age. Duration of valve replacement was 2.95 ± 1.74 years (1 to 7 years). Average time of presentation since onset of symptoms was 4.75 ± 2.77 days (1 to 12 days). Majority was presented with NYHA class IV symptoms (22/40) and 50% patients presented with cardiogenic shock. 85% patients had atrial brillation and the anticoagulation status was inadequate in 62.5% cases. Overall aortic valve involvement was 37.5% (15 patients) and mitral valve involvement was 62.5% (25 patients). Average mean gradient for aortic valve was 64.5 ±4.2 mm of Hg and that in case of mitral valve was 23.4±3.7 mm of Hg. Duration of thrombolytic therapy was individualized. Average total dose of streptokinase per patient was 25,25000 ± 8,69350 U (ranging from 20,00000 to 50,00000 U) with majority (28/40) had received a total 20,00000U of streptokinase. Patients were re-evaluated after thrombolysis with clinical, echocardiographic, and cine-uoroscopic evaluation. Total complications (both major and minor bleeding) occurred in 8 patients. Most of them were minor like injection site hematoma, gum bleeding transient GI bleed (hematemesis), hemoptysis and those were resolved spontaneously with conservative management/observational care. Thrombolysis was unsuccessful in 2 patients and death due to massive hemorrhagic CVA occurred in 2 patients. Overall success rate was 90% (36/40). In conclusion, the present study demonstrates the feasibility of thrombolytic therapy for left-sided prosthetic valve occlusion.

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