scholarly journals Third Re-Do Surgery in a Young Woman with Massive Early Double-Valve Prosthesis and Thromboembolic Stroke

2021 ◽  
Vol 31 (2) ◽  
pp. 367-372
Author(s):  
Andreea-Antonia NICA ◽  
Andrea-Olivia CIOBANU ◽  
Roxana-Cristina RIMBAS ◽  
Alexandru VASILESCU ◽  
Vlad VINTILA ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Severe Disease ◽  
Anticoagulation Therapy ◽  
Valve Prosthesis ◽  
Thromboembolic Stroke ◽  
Mechanical Prosthesis ◽  
Valve Thrombosis ◽  
Valve Function ◽  
History Of ◽  
Valvular Replacement

Valvular heart disease affects more that 100 million people worldwide. Valvular replacement remains the only definite treatment for most of the patients with severe disease. Careful medical management and periodic followup of valve function is mandatory in order to prevent or diagnose prosthesis-related complications. We present a case of extensive mitral and aortic valve thrombosis and possible recurrent endocarditis in a 44-year-old woman non-adherent to anticoagulation therapy, presented with stroke. She also had a history of two mitral and aortic valvular heart replacement surgeries. Comprehensive and repeated imaging was used to evaluate and monitor the patient progression and outcome. Failure of adequate anticoagulation therapy to improve prosthesis function during hospitalization required third re-do surgery for mitral and aortic valve replacement with mechanical prosthesis.

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

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.

scholarly journals Aortic valve leaflet replacement using autopericardium as an alternative approach of aortic valve stenosis treatment: literature review

2021 ◽  
Vol 37 (5) ◽  
pp. 52-60
Author(s):  
M. N. Askadinov ◽  
B. K. Kadyraliev ◽  
S. H. Lilotkhia ◽  
O. G. Musaev ◽  
V. B. Arutyunyan
Keyword(s):  
Aortic Valve ◽  
Anticoagulation Therapy ◽  
Young Patients ◽  
Long Term Results ◽  
Implantation Technique ◽  
Valve Prosthesis ◽  
Continuous Change ◽  
Mechanical Prosthesis ◽  
Aortic Valve Leaflets ◽  
Biological Prostheses

Regarding degenerative defects of the aortic valve, the main method of treatment is dissection of malformed leaflets and placement of prosthetic valve. In most cases, mechanical and biological prostheses are used. Each type of prosthesis has shortcomings related to both the implantation technique and essential medication support to keep it functioning. Patients with implanted mechanical prosthesis need lifelong anticoagulation therapy and constant monitoring of blood coagulation rates, where on the one hand there is a risk of occurring thromboembolic complications, and on the other hand haemorrhagic complications. The peculiarity of biological prostheses is a high probability of degeneration and the need for re-operation, especially in young patients, therefore the implantation of such prostheses is mainly carried out in elderly patients. Despite continuous change and modification of artificial valves, the ideal aortic valve prosthesis does not exist today. Various attempts to replace aortic valve leaflets with artificial and biological materials have not succeeded or gained great recognition. In 2007, Shigeyuki Ozaki introduced a technique to replace the aortic valve leaflets with an autopericardium treated with 0.6 % glutar aldehyde solution. Inspite of the encouraging mid-term results, this surgery has not yet become widespread among cardiac surgeons due to the complicated operating technique and lack of long-term results. Considering the research of literature, experience of different cardiosurgical centers in this field as well as our own experience, there is a need to systematize the results of Ozaki procedure, among patients with aortic valve pathology, presented in the recent publications.

scholarly journals A Rare Case of Partial Aortic Mechanical Valve Thrombosis With Intact Mitral Mechanical Valve Presenting With ST-Elevation Myocardial Infarction Patients

2020 ◽  
Vol 8 ◽  
pp. 232470962096356
Author(s):  
Mazin O. Khalid ◽  
Yury Malyshev ◽  
Arsalan Talib Hashmi ◽  
Sabah Siddiqui ◽  
NeelKumar Patel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Anticoagulation Therapy ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
Presenting Symptoms ◽  
Mechanical Aortic Valve ◽  
Valve Thrombosis ◽  
Aortic Valve Prosthesis

The incidence of mechanical valve thrombosis (MVT) is around 0.4 per 100 patient-years. Mitral valve thrombosis has a higher incidence than aortic valve thrombosis with a nearly 5-fold increase. Various factors contribute to MVT. The most common cause of valve thrombosis is poor adherence/disruption of anticoagulation therapy. Low cardiac output is known to increase the risk of prosthetic valve thrombosis. Other factors such as diabetes, hypertension, and other patient comorbidities might also play a role. Decreased flow promotes hypercoagulability. Lower pressure in the left atrium (and higher velocities in the left ventricle) can partially contribute to the higher incidence of mitral MVT versus aortic MVT. The presenting symptoms usually depend on the severity of the valve thrombosis; nonobstructive valve thrombosis patients have progressive dyspnea, signs of heart failure, and systemic embolization with strokes being the most common complication. In this article, we present a case of a middle-aged woman with a history of mitral and aortic mechanical prosthesis who presented with an ST-segment elevation myocardial infarction and pulmonary edema due to mechanical aortic valve prosthesis thrombosis. She had an isolated mechanical aortic valve prosthesis thrombosis with intact mitral valve, which, to the best of our knowledge, has not yet been described. We performed a literature review by searching PubMed and Embase using the keywords “mechanical valve,” “thrombosis,” “aortic,” and “mitral,” our search did not show similar cases.

Minimally invasive redo aortic valve replacement with a sutureless valve implant

2021 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Valve Prosthesis ◽  
Mechanical Prosthesis ◽  
Invasive Approach ◽  
Replacement Procedure ◽  
Aortic Valve Prosthesis ◽  
Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

scholarly journals Prevention of stroke in chronic andrecurrent atrial fibrillation

2001 ◽  
Vol 24 (3) ◽  
pp. 61 ◽  
Author(s):  
Anne-Maree Kelly ◽  
Debra Kerr ◽  
Ruth Hew
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
American Heart ◽  
Anticoagulation Therapy ◽  
Heart Association ◽  
Chronic Atrial Fibrillation ◽  
Prior History ◽  
Demographic Information ◽  
Thromboembolic Stroke ◽  
History Of

The objective was to determine the proportion of patients presenting to the Emergency Department (ED) in atrialfibrillation (AF) who are at high risk of thromboembolic stroke as defined by the American Heart Association andwho might benefit from anticoagulation therapy.We enrolled all patients identified as having AF between 28th June 1999 and 26th March 2000. Data collectedincluded demographic information, presenting complaint, discharge diagnosis, risk factors for thromboembolic stroke,contraindications to anticoagulation (as defined by the Stroke Prevention in AF Investigators), admission anddischarge medications, and cardiac rhythm on presentation and at discharge.193 patients were identified within the study period. Two patient histories were not available for review. 121 patientshad a prior history of AF. Of these, 65 patients were at high risk for thromboembolic stroke and had no contra-indicationto anticoagulation therapy. 43 (66%) were on Warfarin at presentation but 14 (22%) were on Aspirinand 8 (12%) were on neither.34% of patients with chronic atrial fibrillation presenting to the ED, at high risk of thromboembolic stroke andwithout contra-indication to anticoagulation, were not anticoagulated on presentation. ED attendance provides anopportunity for intervention for the prevention of stroke in this group.

scholarly journals Fifty-one years with an aortic valve prosthesis despite suboptimal anticoagulation: half a century with the Smeloff-Cutter valve

2020 ◽  
Author(s):  
Vincenzo F Tripodi ◽  
Angelo Covino ◽  
Pasquale Fratto ◽  
Frank A Benedetto
Keyword(s):  
Aortic Valve ◽  
Anticoagulant Therapy ◽  
Unusual Case ◽  
Good Health ◽  
Valve Prosthesis ◽  
Valve Regurgitation ◽  
Mechanical Prosthesis ◽  
Aortic Valve Prosthesis ◽  
Long Time ◽  
First Time

Abstract This case report describes an unusual case of a 69-year-old man who had an aortic valve replacement with the Smeloff-Cutter aortic mechanical prosthesis for aortic valve regurgitation at the age of 18 years. Echocardiography revealed a well-suited and well-functioning mechanical prosthesis. Even though the patient did not take any anticoagulant therapy or anti-platelets agent for 12 years, he was in surprisingly good health. To the best of our knowledge, this is the first time a mechanical ‘ball-in-cage’ valve prosthesis has lasted for such a long time without complications, although the patient has not been compliant with the anticoagulant therapy for 12 consecutive years.

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.

scholarly journals Surgery after Failed Transcatheter Aortic Valve Implantation: Indications and Outcomes of a Concerning Condition

2021 ◽  
Vol 11 (1) ◽  
pp. 63
Author(s):  
Mohamed Salem ◽  
Christina Grothusen ◽  
Mostafa Salem ◽  
Derk Frank ◽  
Mohammed Saad ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Postoperative Outcome ◽  
Valve Prosthesis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Study Results ◽  
History Of ◽  
Underlying Causes ◽  
Transcatheter Valve ◽  
Valve Implantation

Objectives: The number of transcatheter aortic valve implantations (TAVI) has increased enormously in recent decades. Transcatheter valve prosthesis failure and the requirement of conventional surgical replacement are expected to attract more focus in the near future. Indeed, given the scarcity of research in this field, the next decade will likely represent the beginning of a period of meaningful exploration of the degenerative changes that occur with transcatheter valves. The current study represents—through a series of consecutive cases—one of the first analyses of the underlying causes of TAVI failure, i.e., degenerative, functional and infective, followed by surgical aortic valve replacement (SAVR) and postoperative outcome. Methods: Between October 2008 and March 2021, 2098 TAVI procedures, including 1423 with transfemoral, 309 with transapical, and 366 with transaortic access, were performed in our institution. Among these, 0.5% (number(n) = 11) required acute SAVR (n = 6) within 7 days (n = 3) or later (n = 2), and were included in the study. Results: Valve stent dislocation was the most common cause of replacement (83%). Causes of replacement within 7 days after TAVI were multifactorial. In the later course, endocarditis was the sole indication for SAVR after TAVI. TAVI with transapical or transaortal approach had a higher EuroSCORE II (10.9 (7.2–35.3) vs. 3.5 (1.8–7.8)). Their 30-day mortality after surgical conversion was higher (67% vs. 20%), when compared to those who underwent a transfemoral procedure. The longest documented survival beyond 30 days was 58 months. Conclusions: The causes of SAVR after TAVI failure are multifactorial, and include biological, physical and infectious factors. An acceptable midterm prognosis may be expected in patients with physical causes when dislocation of the catheter prosthesis is observed; in such cases, emergency conversion is required. Conversion due to infection, as in cases of endocarditis, had the worst outcome. Prognosis after conversion due to degeneration is still problematic, due to a lack of autopsies and the recent history of prosthetic implantations.

Treatment of Mechanical Aortic Valve Thrombosis Fibrinolytic Treatment versus Surgical Intervention: Result of Eight Cases

2010 ◽  
Vol 5 (6) ◽  
pp. 439-443
Author(s):  
Kerem Yay ◽  
Emre Boysan ◽  
Ahmet Irdem ◽  
Erdem Cetin ◽  
Levent Altinay ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valve ◽  
Surgical Intervention ◽  
Mechanical Heart Valve ◽  
Good Alternative ◽  
Valve Prosthesis ◽  
Mechanical Aortic Valve ◽  
Valve Thrombosis

Objective Thrombosis of mechanical heart valve prosthesis is a rare fatal complication after heart valve replacement. Although surgical intervention is the suggested treatment in many series, fibrinolytic treatment offers a good alternative. We describe eight cases with mechanical aortic valve thrombosis and compare their results after fibrinolytic treatment or redo aortic valve replacement. Methods Between February 2008 and March 2009, eight patients with previous mechanical prosthetic aortic valve replacement history were admitted to our center with mechanical aortic valve thrombosis. Four patients were operated, and the remaining four patients received low-dose fibrinolytic treatment. All patients’ data were collected prospectively. Results Two of the four operated patients died. In the fibrinolytic group, all patients totally recovered, and there was no mortality or morbidity during the follow-up period. Conclusions We thought that fibrinolytic treatment is a feasible and effective method for thrombosed mechanical aortic valve. However, much more populated patient groups are needed for the vigorous inference.

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