Bioprosthetic Mitral Valve Thrombosis Research Articles

Bioprosthetic mitral valve thrombosis.

Bioprosthetic mitral valve thrombosis.

Bioprosthetic Mitral Valve Thrombosis: A Multifaceted and Challenging Clinical and Imaging Spectrum

Bioprosthetic Mitral Valve Thrombosis: A Multifaceted and Challenging Clinical and Imaging Spectrum

Thrombolysis for COVID-19-associated bioprosthetic mitral valve thrombosis with shock.

Thrombolysis for COVID-19-associated bioprosthetic mitral valve thrombosis with shock.

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

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.

An Uncommon Case of Bioprosthetic Mitral Valve Thrombosis Complicated by Intracerebral Haemorrhage

An Uncommon Case of Bioprosthetic Mitral Valve Thrombosis Complicated by Intracerebral Haemorrhage

Bioprosthetic mitral valve thrombosis not prevented by novel oral anticoagulant and successfully treated with heparin

We present the case of a bioprosthetic mitral valve thrombosis with formation of a large hypermobile mass on the posterior cusp and diffuse thickening of the remaining prosthetic cusps despite treatment with a novel oral anticoagulant for atrial fibrillation. Bioprosthesis thrombosis occurred 52 months after implantation. Prosthesis function was not relevantly affected by the thrombus and treatment with intravenous unfractionated heparin was initiated. Because of the large hypermobile mass, surgery was scheduled to prevent embolisation. Surprisingly, in the transoesophageal echocardiogram performed upon initiation of surgery, the thrombus could no longer be detected. All echocardiographic evidence of bioprosthesis thrombosis, including the large hypermobile mass and the diffuse cusp thickening, had disappeared during the 48 hours of intravenous treatment with unfractionated heparin. There was no clinical evidence of embolisation during the course of the hospitalisation. Follow-up after one month of anticoagulation with phenprocoumon showed intact bioprosthesis function with no evidence of recurrent thrombus.

Acute Thrombosis of Bioprosthetic Mitral Valve Secondary to Peri-Operative VA-ECMO; The Dangers of Flow Stasis in the Left Atrium

Case report Veno-Arterial (VA) ECMO has been used to help patients recover from cardiogenic shock. VA-ECMO can complicate recovery due to the increase in afterload and decreased flow through the left sided chambers. We present a case of acute bioprosthetic mitral valve (MV) thrombosis in a patient who developed peri-operative cardiogenic shock. A 63 year-old male admitted for acute systolic heart failure found to have coronary artery disease and valvular heart disease underwent MV replacement, tricuspid valve repair and three vessel coronary artery bypass grafting. He developed intraoperative mediastinal bleeding requiring fresh frozen plasma, cryoprecipitate, and factor VII. The patient was unable to be weaned off cardiopulmonary bypass secondary to right ventricular failure. The patient remained centrally cannulated for VA-ECMO and had placement of a femoral intra-aortic balloon pump. The patient was transferred to the ICU in shock and on multiple vasopressors. Due to ongoing mediastinal bleeding, initiation of systemic anticoagulation was delayed by 48 hours. The intraoperative transesophageal echocardiogram (TEE) initially demonstrated a normally functioning bioprosthetic MV. The final intraoperative TEE images following conversion to VA-ECMO showed a poorly opening bioprosthetic MV, Image 1 . A TEE on postoperative day (POD) 2 demonstrated abnormal mobility of the bioprosthetic MV leaflets, left appendage thrombus and smoke-like echogenicity in the left atrium, Image 2 . On POD 5, a TEE demonstrated mean MV gradient of 22 mmHg and worsening of MV mobility secondary to thrombus, Image 3 . Because of concern for MV thrombosis, the patient was taken to the catheterization lab for placement of LV catheter to confirm MV stenosis. A thrombolytic agent was infused via a pulmonary artery (PA) catheter in order to attempt lysis of the MV thrombus. On POD 9, the PA systolic pressures reduced from 50 mmHg to 30 mmHg and the VA-ECMO flow requirements were reduced from 5 to 3.5 Liters per minute. Despite this small improvement in hemodynamics his overall clinical status did not improve. Ultimately the family decided to withdraw care. A post-mortem examination confirmed MV stenosis secondary to thrombosis of the valve extending into the left atrial appendage. Patients in cardiogenic shock who are placed on VA-ECMO are extremely sensitive to the high afterload created by retrograde arterial flow. Our patient developed severe thrombotic MV stenosis secondary to left atrial circulatory stasis when VA-ECMO was initiated. Maintaining adequate left sided flow is crucial to reduce the risk of thrombosis.

Acute Presentation of Bioprosthetic Mitral Valve Thrombosis in a Patient on Venoarterial Extracorporeal Membranous Oxygenation

The management of patients presenting with bioprosthetic valve thrombosis presents a major clinical challenge from a diagnostic and management standpoint.This patient population becomes especially challenging to manage when presenting with cardiogenic shock and additional risks for bleeding. In this clinical conference, the authors present the case of a 64-year-old male who developed intraoperative bioprosthetic mitral valve thrombosis and cardiogenic shock necessitating support with venoarterial extracorporeal membrane oxygenation. The discussion focuses on the diagnostic challenges with transesophageal echocardiography and the difficulty in determining the proper approach to systemic anticoagulation.

Treatment of porcine bioprosthetic mitral valve thrombosis with anticoagulation

A 70-year-old man underwent mitral valve replacement using a porcine bioprosthesis for infective endocarditis. Transthoracic echocardiography revealed thickened leaflets with increased transprosthetic pressure gradient and new regurgitation, 6 months after surgery. He was followed up medically with the diagnosis of early valve degeneration. He ultimately presented with worsening orthopnea 13 months after surgery. Transesophageal echocardiography revealed an immobile round mass attached to the ventricular aspect of the leaflets, which hampered valve opening, suggesting bioprosthetic valve thrombosis. Anticoagulation with heparin and warfarin were effective and transthoracic echocardiography showed normal transprosthetic pressure gradient and disappearance of regurgitation 2 months later.

Two Cases of Acute Bioprosthetic Mitral Valve Thrombosis Immediately After Mitral Valve Replacement

Prosthetic valve thrombosis (PVT) is a rare complication, and most of PVT occurs in patients with mechanical valves. We present 2 extremely rare cases of acute bioprosthetic mitral valve thrombosis immediately after mitral valve replacement under veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and anticoagulant therapy. In Case 1, a 75-year-old woman underwent aortic valve replacement and mitral valve replacement with 23- and 29-mm bioprosthetic valves, respectively. On postoperative day 2, VA-ECMO was started because of hemodynamic compromise. At the initiation of VA-ECMO, transthoracic echocardiography indicated normal bioprosthesis function (Figure 1; see Movie I in the online-only Data Supplement). On postoperative day 9, transesophageal echocardiography revealed severely stenotic bioprosthetic mitral valve, but the bioprosthetic aortic valve was normal (Figure 2; see Movies II and III in the online-only Data Supplement). Emergent percutaneous mitral valvuloplasty was performed, resulting in partial improvement of hemodynamic state. On postoperative day 17, re-mitral valve replacement was performed. The left atrial side of the retrieved bioprosthetic valve leaflet was covered with thrombus, …

Successful thrombolytic treatment of a bio-prosthetic mitral valve thrombosis in a pregnant woman

Even though it is a rare complication, the pro-coagulant condition of pregnancy may predispose to thrombosis of a bio-prosthetic mitral valve (BPMV). We report the successful reduced-dose, slow infusion of tissue plasminogen activator (t-PA) to a BPMV thrombosis in a pregnant woman. When the patient was seen in the emergency clinic she was dyspnoeic and tachycardic and evaluated as NYHA class III-IV. On transthoracic echocardiography (TTE) the BPMV leafl et movement was restricted and a high transmitral valve gradient was measured. Transoesophageal echocardiography showed thrombosis of the BPMV. After slow infusion of t-PA with heparin, on TTE the gradient was decreased with free movement of the BPMV leafl et and with fast clinical improvement.

Early acute thrombosis of bioprosthetic mitral valve presenting with cardiogenic shock

Early thrombosis of bioprosthetic mitral valves is an extremely rare occurrence. We present an unusual case of a patient with polycythemia presenting with cardiogenic shock, secondary to acute thrombosis of a bioprosthetic mitral valve which was placed 14months prior to presentation. Our report also reviews predisposing factors and treatment options for bioprosthetic mitral valve thrombosis.

Bioprosthetic mitral valve thrombosis less than one year after replacement and an ablative MAZE procedure: a case report

Occurrence of bioprosthetic valve thrombosis less than a year after replacement is very uncommon. Here, we describe a case of a 57 year old male, who presented 10 months after receiving a bioprosthetic mitral valve replacement with a two week history of dyspnea on exertion, worsening orthopnea and decreased exercise tolerance. Echocardiography revealed severe mitral regurgitation (MR), thrombosis of the posterior mitral leaflet, left atrial (LA) mural thrombus and a depressed left ventricular ejection fraction of twenty-five percent. Given severe clot burden and decompensated heart failure (New York Heart Association - NYHA class III) repeat sternotomy was done to replace the bioprosthetic mitral valve and remove LA mural thrombus. MR was resolved postoperatively. This brief report further reviews promoting factors, established guidelines and management strategies of bioprosthetic valve thrombosis.

Late Bioprosthetic Mitral Valve Thrombosis: A Link With Postoperative Heparin-Induced Thrombocytopenia?

Bioprosthetic valve thrombosis is considered extremely unlikely, thus usually allowing patients to avoid long-term anticoagulation. The authors report the case of a patient with late bioprosthetic mitral valve thrombosis associated with a history of postoperative heparin-induced thrombocytopenia. The patient successfully underwent mitral valve replacement.

An unusual case of late bioprosthetic mitral valve thrombosis successfully managed with anticoagulation

In this report, we present the case of a patient with hemodynamically significant thrombosis of a mitral bioprosthesis occurring 11 years after valve replacement. The diagnosis was suspected on the basis of a subacute increase in the transvalvular gradient seen on transthoracic echocardiography and was con- firmed by transesophageal echocardiography which disclosed unusual features. A hypercoagulable work up showed raised plasma factor VIII levels. The patient was successfully managed with oral anticoagulation.

Bioprosthetic mitral valve thrombosis in a patient in sinus rhythm after the radiofrequency maze procedure

Bioprosthetic mitral valve thrombosis in a patient in sinus rhythm after the radiofrequency maze procedure

Trombose de prótese biológica mitral: importância do ecocardiograma transesofágico no diagnóstico e acompanhamento pós-tratamento

To report the clinical and echocardiographic findings of bioprosthetic mitral valve thrombosis and the value of transesophageal echocardiography (TEE) in its diagnosis and monitoring of thrombolysis. One hundred and eleven patients with mitral bioprostheses underwent TEE, and 4 out of 7 suspected of having a thrombus on these prostheses were included in the study (mean age = 60.2+/-10.2 years; 2 men). The diagnosis was confirmed with serial TEE and clinical evolution. The morphologic features of the prosthetic leaflets, as well as the presence and characteristics of attached echogenic masses were investigated. The mean gradient through the prosthesis and the valvular area were obtained. The diagnosis of bioprosthetic mitral valve thrombosis was established 48.7+/-55.2 months after surgery. Two patients had ischemic stroke in the early postoperative period. The mean overall gradient was high (11.4+/-3 mmHg) and the valvular area reduced (1.24+/-0.3 cm2). On TEE, echogenic masses on the left ventricular face of the mitral bioprosthesis suggestive of thrombus were evidenced in all patients. On serial TEE (136+/-233 days), in 2 patients the thrombus had disappeared and in 2 others it was smaller after treatment, the mean gradient dropped to 6.2+/-3 mmHg (P = 0.004; 95% CI), and the valvular area increased to 2.07+/-0.4 (P = NS). TEE proved to be useful for detecting bioprosthetic mitral valve thrombosis and was effective in monitoring the treatment in all patients.

An unusual case of bioprosthetic mitral valve thrombosis

Bioprosthetic valve thrombosis and related embolism are considered extremely unlikely, thus allowing most patients to avoid long-term anticoagulation. There is, however, limited experience in the diagnosis and treatment of such a condition. We present the case of a patient with a porcine mitral bioprosthesis who presented with acute thrombosis with unusual echocardiographic features. A favorable outcome was observed after conventional anticoagulant treatment.

Bioprosthetic mitral valve thrombosis: Clinical profile, transesophageal echocardiographic features, and follow-up after anticoagulant therapy

Cardiac bioprosthetic valve thrombosis is frequently found on pathologic examination, but preoperative diagnosis is rarely performed. Four hundred six patients with mitral porcine xenograft bioprostheses were examined by transthoracic echocardiography. Transesophageal echocardiography (TEE) was performed in 161 of the patients, with clinical or echocardiographic criteria of prosthetic malfunction. Fairly homogeneous and echodense masses, attached to the ventricular surface of the mitral bioprosthetic cusps, were detected by TEE in 15 patients. Only 10 patients, in whom diagnosis of bioprosthetic thrombosis was confirmed, are included in this study. After TEE, two patients underwent prosthetic replacement and eight patients received anticoagulants. A new TEE was performed 85.6 ± 29.8 days after anticoagulation in these eight patients. Clinical follow-up was continued for 13.6 ± 8.6 months, and one additional patient underwent surgery during the follow-up. Pathologic examination of removed grafts (three cases) identified these masses as being thrombotic tissue. TEE examination after therapeutic anticoagulation demonstrated complete disappearance of the echogenic masses on bioprosthetic cusps and normal mobility of all leaflets in six cases. In the other two cases, cusp masses were notably reduced, but partially restrictive mobility of affected leaflets persisted, suggesting incomplete resolution of thrombi. Mitral valve prosthetic mean gradient decreased from 11.8 ± 4.5 to 7.6 ± 3.7 mm Hg ( p < 0.001), and mitral valve area increased from 1.13 ± 0.3 to 1.72 ± 0.6 cm 2 ( p < 0.001). Long-term symptomatic improvement after anticoagulation was obtained in seven patients. Thus this study shows that mitral bioprosthetic thrombosis is a relatively frequent cause of valve dysfunction, TEE is useful for detecting thrombus in relation to mitral bioprosthetic valves, and oral anticoagulation is effective in resolving thrombosis on bioprostheses.