A Case of Acute Massive Bioprosthetic Mitral Valve Thrombosis Leading to Fulminant Heart Failure

Bioprosthetic valve thrombosis has been considered to be extremely unlikely, typically freeing patients from the potential complications of long-term anticoagulation. However, there have been several documented cases of bioprosthetic valve thrombosis and there are concerns that its incidence may be underreported. Experience with diagnosis and management of this condition is limited. Here, we present a case of acute massive bioprosthetic mitral thrombosis manifesting as fulminant heart failure.

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Impact of prosthesis-patient mismatch on late outcomes after bioprosthetic mitral valve replacement for mitral regurgitation

10.22541/au.161354809.93823675/v1 ◽

2021 ◽

Author(s):

Yuichiro Kitada ◽

Mamoru Arakawa ◽

Homare Okamura ◽

Kei Akiyoshi ◽

Daijiro Hori ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Effective Orifice Area ◽

Term Survival ◽

Orifice Area ◽

Bioprosthetic Mitral Valve

Background and Aim of the Study: Negative impact of prosthesis-patient mismatch (PPM) on long term survival after valve replacement has been reported. However, the effect of PPM after bioprosthetic mitral valve replacement (MVR) has not yet been well examined. The purpose of this study was to investigate the effect of PPM on late outcomes after bioprosthetic MVR for mitral regurgitation (MR). Methods: A total of 181 patients underwent bioprosthetic MVR between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed for all patients and the effective orifice area (EOA) was calculated using the pressure half-time method. The effective orifice area index (EOAI) was calculated by the formula: EOA/body surface area (BSA). PPM was defined as a postoperative EOAI ≤ 1.2 cm2/m2. The characteristics and outcomes were compared between the groups. Results: There were 34 patients (26.6%) with PPM and 94 patients (73.4%) without PPM. Although proportion of males and BSA were higher in the PPM group, valve size distributions were similar between the two groups. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that PPM was an independent predictor of late mortality (hazard ratio [HR] 3.38; 95% confidence interval [CI] 1.69-6.75; p = .001) and death from heart failure (HR 31.03, 95% CI 4.49-214.40, p < .001). Conclusions: PPM after MVR for MR was associated with long-term mortality and death from heart failure.

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Obstructive bioprosthetic mitral valve thrombosis

Future Cardiology ◽

10.2217/fca-2019-0094 ◽

2020 ◽

Vol 16 (5) ◽

pp. 433-438

Author(s):

Suchith Shetty ◽

Aaqib H Malik ◽

Wilbert S Aronow ◽

Kimberly S Staffey ◽

Ramzi El Accaoui

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Multimodality Imaging ◽

Case Series ◽

Disease Status ◽

Bioprosthetic Valve ◽

Surveillance Imaging ◽

Valve Thrombosis ◽

History Of ◽

Bioprosthetic Mitral Valve

Bioprosthetic valve thrombosis (BPVT) is not uncommon but can be under diagnosed due to the lack of awareness and technical limitations of echocardiography. When suspecting BPVT, it is imperative to consider multimodality imaging to establish the diagnosis as early treatment can alter the clinical course. Here we present a case series of two patients with a history of rheumatic heart disease status post bioprosthetic mitral valve replacement who presented with acute heart failure symptoms. In both cases, supplemental imaging with real-time 3D echocardiography was critical in establishing a diagnosis of BPVT, resulting in timely treatment. These cases support updating current guidelines for the management of patients with bioprosthetic valve replacement to include more frequent surveillance imaging even if patients are asymptomatic.

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An uncommon case of bioprosthetic mitral valve thrombosis with subsequent prosthesis dehiscence

Proceedings of Singapore Healthcare ◽

10.1177/20101058211019434 ◽

2021 ◽

pp. 201010582110194

Author(s):

Raja Ezman Faridz Raja Shariff ◽

Sazzli Kasim

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Intracerebral Haemorrhage ◽

New Left ◽

Signs And Symptoms ◽

Transoesophageal Echocardiography ◽

Anterior Portion ◽

Valve Thrombosis ◽

Uncommon Case ◽

Bioprosthetic Mitral Valve

Bioprosthetic valve thrombosis (BVT) is uncommon. An 82-year-old gentleman presented following a cardioembolic stroke due to a mitral valve infective endocarditis. The patient underwent bioprosthetic mitral valve replacement. Following discharge, he re-presented with weakness due to a new left-sided stroke and right-sided occipital intracerebral haemorrhage. Both transthoracic and transoesophageal echocardiography revealed BVT on the anterior portion of the prosthesis. Following a multidisciplinary team discussion, it was felt that thrombolytics and anticoagulation would be detrimental. The patient continued to worsen and eventually succumbed to congestive cardiac failure. BVT is uncommon, and patients often present with signs and symptoms of heart failure, shock or embolism. There are no guidelines available on managing BVT in patients with concurrent intracerebral haemorrhage, highlighting the importance of multidisciplinary efforts and patient inclusivity in decision making.

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Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.2008 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Polimeni

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Primary Endpoint ◽

Cardiovascular Death ◽

Volume Index ◽

Valve Repair ◽

Percutaneous Valve Repair ◽

Percutaneous Valve

Abstract Background Percutaneous mitral valve repairs has been increasingly performed worldwide. The MITRA-UMG registry provides a snapshot of a real-world clinical data and outcomes. Purpose We sought to investigate predictors of clinical outcomes in patients with mitral regurgitation undergoing percutaneous valve repair. Methods The MITRA-UMG registry retrospectively collected data from consecutive patients with symptomatic moderate-to-severe or severe MR underwent MitraClip implantation. The primary endpoint of interest was the composite of cardiovascular death or rehospitalization for HF. Results Between March 2012 and July 2018, a total of 133 consecutive patients admitted to our institution were included. Acute procedural success was obtained in 95.4% of patients, with no intraprocedural death. The composite primary endpoint of cardiovascular death or rehospitalization for heart failure was met in 50 patients (38%) with cumulative incidences of 7%, 25%, at 30 days and 1 year, respectively. In the Cox multivariate model, NYHA functional class IV, left ventricular end-diastolic volume index (LVEDVi), Euroscore II, independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan-Meier analysis, a LVEDVi >92 ml/m2 was associated with an increased incidence of the primary endpoint. Conclusions In searching the ideal phenotype of patients who benefit most of percutaneous mitral valve repair, those presenting with severely dilated ventricles (LVEDVi >92 ml/m2), high operative risk (EUROSCORE II >7%) or advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis at long-term. Funding Acknowledgement Type of funding source: None

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