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.

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

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Ahmed Mahgoub ◽  
Susy Kotit ◽  
Karim Bakry ◽  
Ahmed Magdy ◽  
Hatem Hosny ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Emergency Treatment ◽  
Maternal Morbidity ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mitral Valve Prosthesis ◽  
Maternal Morbidity And Mortality ◽  
Feasible 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.

scholarly journals Obstructive thrombosis of mitral prosthesis — diagnostic trap during a pandemic

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Diana Lupu ◽  
◽  
Aurel Grosu ◽  
Nadejda Diaconu ◽  
Vitalie Moscalu ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Condition ◽  
Prosthetic Heart Valve ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
First Line Therapy ◽  
Valve Thrombosis ◽  
Mitral Prosthesis ◽  
Prosthetic Mitral Valve ◽  
Heart Valve Thrombosis

Prosthetic obstructive thrombosis, being a major emergency, requires the identification of symptoms of heart failure, which are crucial elements in the early diagnosis and initiation of prompt therapeutic management. Adequate clinical, preclinical and instrumental assessment is the key tactic, used both to confirm the diagnosis and to assess the severity of the general condition and the prognosis of survival of the patient with obstructive thrombosis of the valve prosthesis. Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 63-year-old woman who had undergone mitral valve replacement operation 11 months ago, presenting to the guard room in an extremely serious general condition, in polyvisceral and polysystemic dysfunction syndrome (MODS). A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transthoracic echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred.

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.

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

2002 ◽  
Vol 10 (2) ◽  
pp. 165-166 ◽  
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.

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.

A mitral valve prosthesis and a study of thrombosis on heart valves in dogs

1962 ◽  
Vol 2 (3) ◽  
pp. 168-175 ◽  
Author(s):  
Wolfgang Seidel ◽  
Tetsuzo Akutsu ◽  
Velimir Mirkovitch ◽  
Willem J. Kolff
Keyword(s):  
Mitral Valve ◽  
Heart Valves ◽  
Valve Prosthesis ◽  
Mitral Valve Prosthesis

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.

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