Effect of Oral Anticoagulant during Pregnancy with Prosthetic Heart Valve

2002 ◽  
Vol 10 (4) ◽  
pp. 306-309 ◽  
Author(s):  
Ashok K Srivastava ◽  
Ashok K Gupta ◽  
Arvind V Singh ◽  
Tanveer Husain
Keyword(s):  
Heart Valve ◽  
Oral Anticoagulant ◽  
Oral Anticoagulants ◽  
Prosthetic Heart Valve ◽  
Premature Delivery ◽  
Valve Prosthesis ◽  
Childbearing Age ◽  
Skeletal Deformity ◽  
Mechanical Prosthesis ◽  
Valve Thrombosis

This retrospective study aimed to evaluate the risks and outcome of oral anticoagulant use during pregnancy in women with prosthetic heart valves. Between December 1989 and November 1998, 192 females of childbearing age underwent heart valve replacement with a mechanical prosthesis. There were 37 pregnancies in 30 patients during follow-up. Pregnancy was terminated on medical grounds in 5 cases, there were 2 (6%) spontaneous abortions, and 1 (3%) premature birth of a normal baby who died 24 hours later due to asphyxia. The other 29 pregnancies (91%) went to full term and the mothers continued taking oral anticoagulants until a week before the expected date of delivery, then switched to heparin. There was no thromboembolism, valve thrombosis, or maternal mortality. Three babies (10%) had a skeletal deformity: nasal hypoplasia in all 3, with cleft pinna in 1. Continuation of oral anticoagulants during pregnancy provided adequate protection against thromboembolism and valve thrombosis, but the risks of fetal abnormalities and premature delivery should be explained to women of childbearing age with a mechanical valve prosthesis.

Pregnancy with St. Jude Medical Mitral Valve Prosthesis

2000 ◽  
Vol 8 (2) ◽  
pp. 127-129
Author(s):  
Birol Yamak ◽  
Mustafa Emir ◽  
Tulga A Ulus ◽  
Ayşen Aksöyek ◽  
Zafer Işcan ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Heart Valves ◽  
Oral Anticoagulant Therapy ◽  
Premature Delivery ◽  
Valve Prosthesis ◽  
Childbearing Age ◽  
Jude Medical ◽  
Mitral Valve Prosthesis ◽  
Maternal Morbidity And Mortality ◽  
Valve Thrombosis

From 1986 to 1995, 513 young women of childbearing age (11 to 45 years) underwent mitral valve replacement with a bileaflet St. Jude Medical prosthesis. Twenty-one patients became pregnant within 3 years postoperatively. The mean age of these patients at the onset of pregnancy was 27 ± 8 years (range, 16 to 43 years). Follow-up was complete for all pregnant patients. Of 11 who continued to take warfarin during pregnancy, one had a premature delivery, 2 had spontaneous abortions, and 8 had therapeutic abortions. Five patients who ceased oral anticoagulant therapy had normal deliveries but 4 underwent reoperation for valve thrombosis postnatally, with concurrent left hemiplegia in one case. The other 5 patients adhered to an anticoagulation protocol for pregnancy; there were 3 normal deliveries, 1 premature birth, and 1 abortion. There is a high risk of thromboembolism in patients with mechanical heart valves whose anticoagulants are interrupted during pregnancy. We believe that careful supervision can reduce maternal morbidity and mortality.

scholarly journals Mechanical Prosthetic Heart Valve Thrombosis in a Patient Receiving Rivaroxaban

Cardiology ◽  
2019 ◽  
Vol 143 (3-4) ◽  
pp. 116-120 ◽  
Author(s):  
Daniela Marisa Carvalho Silva ◽  
Ana Braga ◽  
Ilídio de Jesus ◽  
José Neves
Keyword(s):  
Heart Valve ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Prosthetic Heart Valve ◽  
Mechanical Valves ◽  
Valve Thrombosis ◽  
Mitral Prosthesis ◽  
Heart Valve Thrombosis

Direct oral anticoagulants are not approved for use in patients with mechanical valves. When used to replace vitamin K antagonists, they may cause catastrophic consequences. The authors describe the case of a patient who, after discontinuation of warfarin and introduction of rivaroxaban, developed thrombosis of his mechanical mitral prosthesis.

A Comparison of a Moderate with Moderate-high Intensity Oral Anticoagulant Treatment in Patients with Mechanical Heart Valve Prostheses

1997 ◽  
Vol 77 (05) ◽  
pp. 0839-0844 ◽  
Author(s):  
Vittorio Pengo ◽  
Fabio Barbero ◽  
Alberto Banzato ◽  
Elisabetta Garelli ◽  
Franco Noventa ◽  
...  
Keyword(s):  
Heart Valve ◽  
High Intensity ◽  
Oral Anticoagulant ◽  
Oral Anticoagulants ◽  
Mechanical Heart Valve ◽  
Moderate Intensity ◽  
Minor Bleeding ◽  
Anticoagulant Treatment ◽  
Oral Anticoagulant Treatment ◽  
Valve Prostheses

SummaryBackground. The long-term administration of oral anticoagulants to patients with mechanical heart valve prostheses is generally accepted. However, the appropriate intensity of oral anticoagulant treatment in these patients is still controversial.Methods and Results. From March 1991 to March 1994, patients referred to the Padova Thrombosis Center who had undergone mechanical heart valve substitution at least 6 months earlier were randomly assigned to receive oral anticoagulants at moderate intensity (target INR = 3) or moderate-high intensity (target INR = 4). Principal end points were major bleeding, thromboembolism and vascular death. Minor bleeding was a secondary end-point.A total of 104 patients were assigned to the target 3 group and 101 to the target 4 group; they were followed for from 1.5 years to up 4.5 years (mean, 3 years). Principal end-points occurred in 13 patients in the target 3 group (4 per 100 patient-years) and in 20 patients in the target 4 group (6.9 per 100 patient-years). Major hemorrhagic events occurred in 15 patients, 4 in the target 3 group (1.2 per 100 patient-years) and 11 in the target 4 group (3.8 per 100 patient-years) (p = 0.019). The 12 recorded episodes of thromboembolism, 4 of which consisted of a visual deficit, were all transient ischemic attacks, 6 in the target 3 group (1.8 per 100 patient-years) and 6 in the target 4 group (2.1 per 100 patient- years). There were 3 vascular deaths in each group (0.9 and 1 per 100 patient-years for target 3 and target 4 groups, respectively). Minor bleeding episodes occurred 85 times (26 per 100 patient-years) in the target 3 group and 123 times (43 per 100 patient-years) in the target 4 group (p = 0.001).Conclusions. Mechanical heart valve patients on anticoagulant treatment who had been operated on at least 6 months earlier experienced fewer bleeding complications when maintained on a moderate intensity regimen (target INR = 3) than those on a moderate-high intensity regimen (target INR = 4). The number of thromboembolic events and vascular deaths did not differ between the two groups.

Comparison of Thrombolysis Versus Surgery as a First Line Therapy for Prosthetic Heart Valve Thrombosis

2011 ◽  
Vol 107 (2) ◽  
pp. 275-279 ◽  
Author(s):  
Siegmund Keuleers ◽  
Paul Herijgers ◽  
Marie-Christine Herregods ◽  
Werner Budts ◽  
Christophe Dubois ◽  
...  
Keyword(s):  
Heart Valve ◽  
Prosthetic Heart Valve ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Valve Thrombosis ◽  
Heart Valve Thrombosis

Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients

2006 ◽  
Vol 21 (2) ◽  
pp. 185-190 ◽  
Author(s):  
Fidel Manuel Cáceres-Lóriga ◽  
Horacio Pérez-López ◽  
Karel Morlans-Hernández ◽  
Humberto Facundo-Sánchez ◽  
José Santos-Gracia ◽  
...  
Keyword(s):  
Heart Valve ◽  
Prosthetic Heart Valve ◽  
First Choice ◽  
Valve Thrombosis ◽  
Heart Valve Thrombosis

The Influence of the Aortic Root Geometry on Flow Characteristics of a Prosthetic Heart Valve

2015 ◽  
Vol 137 (5) ◽  
Author(s):  
Oleksandr Barannyk ◽  
Peter Oshkai
Keyword(s):  
Aortic Valve ◽  
Heart Valve ◽  
Aortic Root ◽  
Reynolds Shear Stress ◽  
Prosthetic Heart Valve ◽  
Flow Characteristics ◽  
Aortic Pressure ◽  
Valve Prosthesis ◽  
Aortic Heart Valve ◽  
Valve Diseases

In this paper, performance of aortic heart valve prosthesis in different geometries of the aortic root is investigated experimentally. The objective of this investigation is to establish a set of parameters, which are associated with abnormal flow patterns due to the flow through a prosthetic heart valve implanted in the patients that had certain types of valve diseases prior to the valve replacement. Specific valve diseases were classified into two clinical categories and were correlated with the corresponding changes in aortic root geometry while keeping the aortic base diameter fixed. These categories correspond to aortic valve stenosis and aortic valve insufficiency. The control case that corresponds to the aortic root of a patient without valve disease was used as a reference. Experiments were performed at test conditions corresponding to 70 beats/min, 5.5 L/min target cardiac output, and a mean aortic pressure of 100 mmHg. By varying the aortic root geometry, while keeping the diameter of the orifice constant, it was possible to investigate corresponding changes in the levels of Reynolds shear stress and establish the possibility of platelet activation and, as a result of that, the formation of blood clots.

scholarly journals Experimental substantiation of the design of a prosthetic heart valve for «valve-in-valve» implantation

2017 ◽  
Vol 19 (2) ◽  
pp. 69-77
Author(s):  
K. Yu. Klyshnikov ◽  
E. A. Ovcharenko ◽  
A. N. Stasev ◽  
T. V. Glushkova ◽  
Yu. A. Kudryavtseva ◽  
...  
Keyword(s):  
Heart Valve ◽  
Prosthetic Heart Valve ◽  
Hydrodynamic Characteristics ◽  
Implantation Technique ◽  
Effective Orifice Area ◽  
Test Machine ◽  
Critical Surface ◽  
Valve Prosthesis ◽  
Valve In Valve ◽  
Valve Implantation

The aim of the study was to perform a series of in vitro tests of a prototype of the developing heart valve prosthesis to evaluate its functional characteristics. Materials and methods. In this work we have used the frames and full prototypes of the prosthesis, consisting of a stent-like stainless steel support frame with mounted biological leaflets and cover. The authors evaluated the calculated and experimental forces necessary for the displacement of the sutureless implanted prosthesis using the test machine under uniaxial tension. The risk of defects and damages to the supporting framework as a result of implantation was evaluated by scanning electron microscopy. The hydrodynamic characteristics of the prosthesis were investigated under physiological conditions and «valvein-valve» implantation. Evaluation of the ergonomics and applicability of the proposed construction on the cadaver heart model of cattle was carried out. Results. As a result of the forces assessment, it was found that the force required to shear the prosthesis was 3.12 ± 0.37 N, while the calculated value was 1.7 N, which is significantly lower than the obtained value. The comparison of the images obtained with small and large magnifications demonstrated the absence of critical surface defects. Additional analysis under the super-large magnifications also did not reveal problem areas. During the hydrodynamic study, it was shown that the average transplant gradient increased slightly from 2.8–3.4 to 3.2–4.5 mm Hg for the initial prosthesis and the «valve-in-valve» complex, respectively. The decrease of the effective orifice area was 6–9% relative to the initial one. Evaluation of the implantation technique demonstrated the consistency of the approach: the use of the developed holder in combination with the balloon implantation system made it possible to position the prosthesis throughout the procedure. Conclusion. The series of tests demonstrates the consistency of the developed design, intended for the replacement of a failed prosthetic valve of the heart with the «valve-in-valve» implantation.

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