scholarly journals Thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in females with prosthetic heart valves

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G G Sefieva ◽  
U M Shadrina ◽  
E V Karelkina ◽  
O A Li ◽  
A E Bautin ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Postpartum Period ◽  
Heart Valves ◽  
Nyha Class ◽  
Clinical Manifestations ◽  
Mechanical Valve ◽  
Prosthetic Heart Valves ◽  
Valve Prosthesis ◽  
Mechanical Prostheses ◽  
Hemorrhagic Complications

Abstract Background/Introduction Women with mechanical prosthetic heart valves are at greatest risk of developing complications.The main reason is that mechanical prosthetic heart valves require lifelong anticoagulation to reduce the high risk of associated thrombotic and hemorrhagic complications. Purpose The main goal of this study was to estimated risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in women with prosthetic heart valves Methods According to retrospective cohort analyses in this study were included 70 patients with prosthetic heart valves who delivered in a specialized perinatal center from October 2010 to February 2020. All the patients were divided into two groups depending on prosthesis type: mechanical prostheses (44 deliveries in 44 patients), biological prostheses (22 deliveries in 19 patients). All patients were performed ECHO (Vivid 7, GE, USA). The average age were 30.7±5.2 years. The N-terminal brain natriuretic propeptide (NT-proBNP) concentration was determined by the quantitative electrochemiluminescence method using a Cobas E 411 analyzer (Roche, Switzerland). The activity of the anti –Xa factor was measured by chromogenic assays. Results In 9 (21.4%) pregnants with a mechanical valve prosthesis (MVP), prosthetic thrombosis was recorded until 2016. In 1 patient with mechanical valve prosthesis (2%) during pregnancy was complicated by an acute cerebral circulation disorder. Since 2016 there were monitored the activity of the anti –Xa factor. In 7 patients on the background of a change in anticoagulant therapy, pregnancy stopped in the early stages. Before pregnancy, 31.4% of the patients didn't have heart failure clinical manifestations, but in 12 (17.1%) patients during pregnancy had increase in NYHA Class maximum to NYHA Class III. The average NT-proBNP concentration was 912.3±1586.6 pg / ml. The frequency of the cesarean section in both groups was high: in patients with mechanical valve prosthesis in 78.5% and in the group of patients with biological valve prostheses in 68.1% of cases. There were not registered any new cases of prosthetic thrombosis after delivery, however, 9 patients had hemorrhagic complications in the early postpartum period, which required relaparotomy and blood transfusions. Regardless of frequent complications during pregnancy and in the postpartum period, no fatal outcomes have been reported. Conclusion The absence of mortality over the 9-years old observation and delivery in patients with valvular prostheses demonstrates the feasibility of monitoring and delivery of this category of patients in a specialized multidisciplinary medical center with experience in managing patients during pregnancy with valvular prostheses on anticoagulant therapy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Efficiency of pharmacogenetic approach to anticoagulant therapy in patients with prosthetic heart valves

Kardiologiia ◽  
2019 ◽  
Vol 59 (9S) ◽  
pp. 25-30
Author(s):  
E. V. Gorbunova ◽  
V. V. Rozhnev ◽  
A. V. Ponasenko ◽  
Olga Leonidovna Barbarash
Keyword(s):  
Anticoagulant Therapy ◽  
Therapeutic Range ◽  
Heart Valves ◽  
Warfarin Therapy ◽  
Molecular Genetic ◽  
Time Frame ◽  
Prosthetic Heart Valves ◽  
Main Diagnosis ◽  
Mechanical Prostheses ◽  
Time Required

Background. This study examined clinical, demographic, anthropometric, and inheritance factors that influence individual sensitivity to warfarin therapy after heart valve surgery. The clinical significance of the pharmacogenetic approach was assessed using the individual time frame and time spent in the INR therapeutic range. Aims. We determined the clinical outcome of the pharmacogenetic approach at the start of warfarin therapy in patients with prosthetic heart valves. Materials and methods. The study included 915 patients, of which 512 women and 403 men (mean age 56±10 years), living in Western Siberia. Rheumatic heart disease was the main diagnosis that caused the acquired defect. Mechanical prostheses were used in 70% of cases of cardiac surgery. Real-time polymerase chain reaction used for molecular genetic testing. Results. The frequencies of the alleles and genotypes of CYP2C9 and VKORC1 in the study population of patients with heart valves prosthetic correspond to the distribution in Caucasoid populations. The use of pharmacogenetic testing results at the beginning of warfarin therapy reduced the time required for selecting a therapeutic dose of anticoagulant by 2 times and increased the duration of stay in the INR therapeutic range by 20.2%. Conclusion. The use of the pharmacogenetic approach at the begin‑ ning of warfarin therapy contributes to the effectiveness and safety of anticoagulant therapy in this category of patients.

scholarly journals Stuck Mitral Valve with Thromboembolic Stroke Managed with Anticoagulation and Mechanical Thrombectomy

2020 ◽  
pp. 10-15
Author(s):  
Akshat Jain ◽  
Gurkirat Singh ◽  
Aniruddha Kaushik ◽  
Rahul Singla ◽  
Narendra Omprakash Bansal
Keyword(s):  
Mitral Valve ◽  
Heart Valves ◽  
Mechanical Valve ◽  
Developed Countries ◽  
Prosthetic Heart Valves ◽  
Valve Prosthesis ◽  
Short Term ◽  
Adequate Knowledge ◽  
Mitral Valve Prosthesis ◽  
Valve Thrombosis

Heart valve replacements are commonly performed these days in India with mitral valve replacement being most common of all. Thromboemboli are a major source of morbidity in patients with prosthetic heart valves. The incidence of clinically recognizable events ranges from 0.6% to 2.3% per patient-year. Mechanical valve thrombosis is another common complication, incidence of which is estimated at 0.3% to 1.3% per patient-year in developed countries, but as high as 6% per patient-year in developing countries. Management of either complication in these patients requires adequate knowledge and clinical experience. We here describe a rare case of a patient who came to us with both complication of stuck mitral valve prosthesis and embolic stroke simultaneously. We here discuss the approach, monitoring and management of these patients, the clinical difficulties we faced in our case, immediate and short term prognosis of our patient.

Modeling of Tissue Fatigue Damage in Bio-Prosthetic Heart Valve

2011 ◽  
Author(s):  
Caitlin Martin ◽  
Wei Sun
Keyword(s):  
Fatigue Damage ◽  
Heart Valve ◽  
Anticoagulant Therapy ◽  
Heart Valves ◽  
Prosthetic Heart Valve ◽  
Bovine Pericardium ◽  
Prosthetic Heart Valves ◽  
Mechanical Valves ◽  
In Vivo Degradation

Bio-prosthetic heart valves (BHVs) with leaflets made of glutaraldehyde-treated bovine pericardium (GLBP), have been used extensively to replace diseased heart valves. BHVs display superior hemodynamics to mechanical valves and eliminate the need for anticoagulant therapy; however, they exhibit poor durability resulting from in vivo degradation and fatigue damage of the leaflets.

scholarly journals Post Radiotherapy Lesions of the Heart Valves. Principles of Diagnosis and Results of Treatment

Kardiologiia ◽  
2019 ◽  
Vol 59 (3) ◽  
pp. 36-42
Author(s):  
R. M. Muratov ◽  
S. I. Babenko ◽  
A. S. Sachkov ◽  
N. N. Soboleva ◽  
E. A. Andrianova
Keyword(s):  
Radiation Therapy ◽  
Heart Disease ◽  
Aortic Valve ◽  
Coronary Arteries ◽  
Heart Valves ◽  
Severe Heart Failure ◽  
Clinical Manifestations ◽  
Cardiac Complications ◽  
Valve Prosthesis ◽  
Thoracic Irradiation

Background. The use of radiation therapy for the treatment of tumors of the chest сan lead to the development of cardiac pathology, including that of the valves and coronary arteries. Study aim: to analyze the specifics of post-radiation lesions of the valvular apparatus and coronary arteries, and to assess the immediate results and risks of surgical correction of detected defects. Materials and  methods. In the Emergency department of surgery of acquired heart disease of A. N. Bakulev National Medical Research Center of Cardiovascular Surgery in the period from 2004 to 2017 were examined and operated 46 patients aged 35–81 years (mean age 56±12.4 years, 80 % women). The period from primary irradiation of the chest to surgical treatment of valvular pathology ranged from 4 to 40 years. Indications for thoracic radiotherapy were Hodgkin’s lymphoma in 23 patients (50 %), breast cancer – in 20 (43 %). Results. Stenosis of the aortic valve was the leading defect in 42 patients (91 %). According to coronary angiography, coronary artery disease was diagnosed in 31 patients (67 %). Isolated aortic valve prosthesis was performed in 14 (30 %) patients, other operations were combined. Hospital mortality was 11 % (5 patients). There were no deaths among patients who underwent radiation therapy after mastectomy. Main nonlethal complications were: pericardial effusion in 6 patients (13 %), hydrothorax requiring repeated pleural punctures in 5 patients (11 %). Conclusion. The variety of clinical manifestations of radiation heart disease and its progressive nature emphasize the need for long-term dynamic observation of patients after thoracic irradiation in order to timely identify the pathology and eliminate the risk of sudden cardiac complications and the development of severe heart failure decompensation.

scholarly journals P1521 Prosthetic heart valve-related stroke: a single center experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Almaghraby ◽  
M Abdelnabi ◽  
Y Saleh ◽  
O Abdelkarim ◽  
O Ozden Tok ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Heart Valve ◽  
Heart Valves ◽  
Hemorrhagic Stroke ◽  
Mechanical Valve ◽  
Prosthetic Heart Valves ◽  
Single Center ◽  
Single Center Experience ◽  
Valve Prostheses

Abstract OnBehalf YIG-CVR Introduction Thromboembolic events or bleeding are by far the most frequent complications of prosthetic heart valves. Cerebrovascular stroke is one of the major thromboembolic complications of anticoagulation-related issues of prosthetic heart valves. Aim of the work To determine the pattern and risk factors of acute stroke in patients with prosthetic heart valves. Methods and Patients A retrospective single-center analysis of the database registry of consecutive acute stroke patients with mitral or aortic heart valve prostheses admitted to a tertiary care stroke specialized center from 01/01/2012 to 01/12/2017. All patients were examined by a certified neurologist and underwent a complete work-up evaluation (Computed Tomography or Magnetic Resonance Imaging, Carotid Doppler ultrasound examination, complete blood tests, and electrocardiogram) and a transthoracic echocardiography (TTE) examination as well as transesophageal echocardiography (TOE) if valve dysfunction or thrombosis were suspected. Results 214 patients with mitral or aortic valve prostheses were admitted by acute stroke in the duration from 01/01/2012 to 01/12/2017 with a mean age of 44 ± 15 years, 132 were males (61.7%) and 178 patients had mechanical valves (83.2%). 135 patients had mitral prosthesis (63.1%) and ischemic stroke was encountered in 151 patients (70.6%). Conclusion In a single center experience, mechanical prosthesis at the mitral valve position was associated with higher incidence of ischemic stroke. Proper close follow-up of INR levels as well as the surgical shift to biological instead of mechanical valve should decrease significantly the incidence of prosthetic valve related strokes. Baseline, clinical and other parameters Patients (n = 214) Age (years) 44 ± 15 Mechanical valve 178 (83.2%) Atrial Fibrillation 101 (47.2%) Rheumatic Heart Disease 175 (81.8%) Left ventricular ejection fraction (%) 54 ±13 Mitral Only 135 (63.1%) Aortic Only 51 (23.8%) Double Valve Prosthesis 28 (13.1%) Ischemic stroke 151 (70.6%) Hemorrhagic stroke 47 (22%) Both ischemic and hemorrhagic stroke 16 (7.4%) Data are represented as mean(±SD) or number (Percentage) Abstract P1521 Figure. Valve sites

Circulating Platelet Factors (Beta Thromboglobulin, Platelet Factor 4) In Patients With Prosthetic Heart Valves

1981 ◽  
Author(s):  
K Andrassy ◽  
H Zebe ◽  
J Koderisch ◽  
A Duczek ◽  
E Ritz
Keyword(s):  
Heart Valves ◽  
Prosthetic Heart Valves ◽  
Valve Prosthesis ◽  
Platelet Factor ◽  
Protein Levels ◽  
Platelet Protein ◽  
Mitral Valve Prosthesis ◽  
Significant Difference ◽  
Aortic Valve Prosthesis ◽  
Induced Aggregation

Despite anticoagulation, thromboembolic complications are frequent in patients with heart valve prosthesis (HVP). The present study was performed to investigate whether activation of platelets could be demonstrated in such patients. Platelet proteins in the circulation were measured as an index of platelet activation. Pat.: 33 pat. with mitral valve prosthesis (MVP) (19 with Bjφrk- Shiley (BS) and 14 pat. with Starr Edwards type (SE)) and 54 pat. with aortic valve prosthesis (35 BS; 10 SE; 9 bioprosthesis (BP). All pat. were anticoagulated (Dicumarol). Results : In MVP, a significant difference between BS and SE was observed with respect to LDH (247±48 vers. 474± 246) (p<0.05) but not with regard to Beta-TG and PF 4. There was no difference of platelet protein levels in presence/absence of atrial fibrillation. In 35% Beta TG (> 53 ng/ml) and PF 4 ( > 11 ng/ml) were above X±2 SD of CO. ADP and collagen induced aggregation (MA) was unchanged in all pat. (collagen 401 12; ADP 32±11; CO: collagen 39±7; ADP 32±6). In pat. with demonstrable hemolysis (LDH >250 IU), a significant correlation was observed between LDH and Beta TG/PF 4 both in MVP and AVP. MVP and AVP differed with respect to LDH (higher in AVP, p<0.05) and PF 4 (higher in MVP (p<0.01) but not with respect to Beta TG (differences of elimination of TG and PF 4?). Comment : In a high proportion of patients with HVP platelets are activated. The observation of elevated platelet indicator proteins is in agreement with previous findings of decreased platelet survival in HVP (Weily, H., New Engl. J. Med. 290, 534, 1974). Elevated platelet prot.may identify risk of thromboembolism.

Impact of prosthetic heart valves on pregnancy in Bangladeshi women

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 446-452 ◽  
Author(s):  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Sanjoy Kumar Saha ◽  
Sabita Mandal ◽  
Kamrul Hasan ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Heart Valve ◽  
Heart Valves ◽  
Prosthetic Heart Valve ◽  
Study Groups ◽  
Prosthetic Heart Valves ◽  
Group I ◽  
Mechanical Prostheses ◽  
Warfarin Embryopathy ◽  
Group Ii

Background: This study evaluated pregnancy outcome in women with a prosthetic heart valve, especially with the oral anticoagulation therapy that must be weighed against the risk of intracardiac thrombosis. Methods: This multicenter, retrospective, cohort study was undertaken between January 2012 and June 2017. The principal maternal outcome variables included bleeding and thromboembolic complications, infective endocarditis, prosthetic valve thrombosis and heart failure. However, the main foetal outcome variables included miscarriage, mortality, preterm baby, warfarin embryopathy, low birthweight and the mode of delivery. Results: A total of 265 pregnancies in women with prosthetic heart valves were evaluated in two groups: Group I (n = 182) covers a mechanical valve, while Group II (n = 82) covers a bioprosthetic valve. The mean age of the patients was 25.2 ± 2.5 years and 24.5 ± 5.2 years in Group I and Group II, respectively. Approximately 80% of the patients had normal echocardiography findings. However, Group I (mechanical prostheses) has a higher incidence (11.54%) of thrombus formation in comparison with the bioprostheses. Hemorrhagic complications and spontaneous miscarriage were statistically significant (p⩽0.05) between the study groups. However, normal pregnancy outcome (91.57%) was significantly higher (p⩽0.05) in Group II compared to Group I (61.54%). Mean birthweight and mean APGAR score were found normal in both study groups. Only 2.75% of patients have warfarin embryopathy in Group I. Furthermore, comparison of SF-36 scores for HRQOL (Health-Related Quality of Life) before and after pregnancy were statistically insignificant among the study population. Conclusion: Proper antenatal care and early risk stratification are the fundamental measures to improve the maternal and foetal outcomes in a patient with a prosthetic heart valve.

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