Thrombosis of mechanical mitral valve prosthesis during pregnancy: An ongoing “saga” in need of comprehensive solutions

Emergency treatment for thrombosed mechanical valve prothesis during pregnancy is not uncommon in low- and middle-income countries. The presence of a mechanical valve continues to be an important cause of maternal morbidity and mortality. There is a pressing need for increasing awareness and feasible solutions for this huge problem. We here describe four patients who needed emergency treatment for thrombosis of mechanical valve prothesis during pregnancy and review the evolving comprehensive strategies for dealing with this issue.

Download Full-text

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

Cardiology and Angiology An International Journal ◽

10.9734/ca/2020/v9i230130 ◽

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.

Download Full-text

Acute Thrombotic Obstruction of Mitral Valve Prosthesis: Low Protein C Level

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000218 ◽

2002 ◽

Vol 10 (2) ◽

pp. 165-166 ◽

Cited By ~ 1

Author(s):

Toshihiro Ohata ◽

Tetsuo Sakakibara ◽

Hiroshi Takano ◽

Toru Ishizaka

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Protein C ◽

Mechanical Valve ◽

Protein S ◽

Valve Prosthesis ◽

Normal Value ◽

Low Protein ◽

Mitral Valve Prosthesis

A 51-year-old female underwent redo mitral valve replacement with a pericardial bioprosthesis because of acute thrombotic obstruction of a mechanical valve, in spite of adequate anticoagulation with warfarin. Her protein C level was 24% of the normal value and protein S was reduced to 54% of normal.

Download Full-text

Pregnancy with St. Jude Medical Mitral Valve Prosthesis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230000800208 ◽

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.

Download Full-text

Successful Use of Two Thrombolytic Drugs in Prosthetic Mitral and Aortic Valve Thrombosis

Pharmaceutical and Biomedical Research ◽

10.18502/pbr.v5i4.2399 ◽

2020 ◽

Author(s):

Shayesteh Gheibi ◽

Aliasghar Farsavian ◽

Maryam Nabati ◽

Gohar Eslami

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Anticoagulation Therapy ◽

Mechanical Valve ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

First Line Therapy ◽

Mitral Valve Prosthesis ◽

Valve Thrombosis ◽

Mobile Mass

Introduction: Prosthetic valve thrombosis is a rare and severe complication of valve replacement, most often encountered with a mechanical prosthesis. The significant morbidity and mortality associated with this condition warrant rapid diagnostic evaluation. Although surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative. Case Description: In this case report, we describe a 46-year-old man with a history of the mitral valve and aortic valve replacement 2 years ago. In echocardiography, we detected a mobile mass on the atrial side of the mitral valve prosthesis and a fixed one on the leaflet of the mechanical aortic valve with a high gradient. To save his life, we used double thrombolytic therapy considering the patient’s hemodynamic situation and the risk of bleeding. Although a routine dose of reteplase and streptokinase was considered, we administered these two thrombolytic drugs together within 72 hours. Conclucsion: Ultimately we succeeded with this method without any significant or life-threatening adverse effects, and the patient was discharged after an optimal anticoagulation therapy.

Download Full-text