Mechanical Mitral Valve Thrombosis Research Articles

Systemic thrombolysis for mechanical prosthetic valve thrombosis - case report and review of literature

Prosthetic valve thrombosis is one of the life-threatening complications in patients with prosthetic heart valves. It is more common in mechanical prosthetic valves in the setting of inadequate or missing anticoagulation. Besides optimization of anticoagulation urgent surgery or thrombolytic therapy should be considered but both are associated with an increased risk for complications and mortality. We report a case of a patient with imaging data for mechanical prosthetic mitral valve thrombosis. Considering the individual patient’s characteristics and the published guidelines we decided to perform systemic thrombolysis with ultra-slow low-dose infusion of tissue-type plasminogen activator. The therapy was successful without any bleeding or thromboembolic complications. 

Multiple Emboli Caused by Mechanical Mitral Valve Thrombosis: A Case Report

We present the case of a 51-year-old woman with a history of atrial fibrillation and rheumatic heart disease who underwent a prosthetic mitral valve replacement two years ago. Despite receiving anticoagulant therapy, this patient experienced embolisms, including embolic strokes and a coronary embolus, over a month. Following a cardiology evaluation, it was determined that mechanical valve thrombosis was the primary source of embolism, and embolisms ceased following a replacement. This case report illustrates the difficulty in diagnosing prosthetic valve thrombosis as a source of multiple emboli in patients receiving adequate anticoagulant therapy, a rare but potentially fatal complication of mechanical valve replacement.

Diagnosis of Left-Sided Mechanical Prosthetic Valve Thrombosis: A Pictorial Review.

Although transcatheter valve therapy is rapidly evolving, surgical valve replacement is still required in many patients with severe left-side valve stenosis or regurgitation, the mechanical bi-leaflet heart valve being the standard prosthesis type in younger patients. Moreover, the prevalence of valvular heart disease is steadily increasing, especially in industrialized countries, and the problem of lifelong efficient anticoagulation of these patients remains fundamental, especially in the context where vitamin K antagonists continue to be the current standard of anticoagulation despite a level of oscillating anticoagulation. In this setting, avoiding prosthetic valve thrombosis after surgery is the number one objective for both the patient and the responsible physicians. Although rare, this complication is life threatening, with the sudden onset of acute cardiac failure such as acute pulmonary edema, cardiogenic shock, or sudden cardiac death and inadequate anticoagulation remaining the leading cause of prosthesis thrombosis, along with other risk factors. The availability of multimodal imaging techniques enables and encompasses to a full extent the diagnosis of mechanical valve thrombosis. The gold-standard diagnostic methods are transthoracic and transesophageal echocardiography. Moreover, 3D ultrasound has undoubted value in giving a more accurate description of the thrombus's extension. When transthoracic and transesophageal echocardiography are uncertain, the multidetector computer tomography examination is an important complementary imaging method. Fluoroscopy is also an excellent tool for evaluating the mobility of prosthetic discs. Each method complements the other to differentiate an acute mechanical valve thrombosis from other prosthetic valve pathologies such as pannus formation or infective endocarditis and aids the physician in accurately establishing the treatment method (surgical or pharmaceutical) and its optimal timing. The aim of this pictorial review was to discuss from an imagistic perspective the mechanical prosthetic aortic and mitral valve thrombosis and to provide an overview of the essential role of non-invasive exploration in the treatment of this severe complication.

Mechanical prosthetic mitral valve thrombosis during dabigatran treatment

Dabigatran has been approved for prevention of thromboembolic complications in non-valvular atrial fibrillation. We present a case of a mechanical prosthetic mitral valve thrombosis during anticoagulation with dabigatran, switched in the last three months after 10 years treatment with warfarin. The patient presented with acute respiratory failure and decompensated heart failure. She was initially treated with unfractioned heparin and then was sent for emergency surgery for cardiogenic shock. As emerging from contemporary evidence and as recommended by guidelines, dabigatran, as well as the other direct oral anticoagulants, should be avoided in patients with mechanical valve prosthesis. Echocardiography is indicated if dyspnoea develops in such patients.

Successful Thrombolytic Therapy Using Ultraslow Low-Dose Infusion During Pregnancy for Mitral Mechanical Valve Thrombosis: A Case Series and Review of the Literature.

Pregnancy in women with mechanical heart valves significantly increases the risk of maternal mortality or severe morbidity.Non-compliance with anticoagulant therapy and/or less frequent monitoring of therapeutic levels during pregnancy can result in serious complications such as valve thrombosis and thromboembolism.Thrombolytic therapy with low-dose tissue-type plasminogen activator can be an attractive alternative to surgical valve replacement and medical treatment in appropriately selected pregnant women with thrombosis of a mechanical valve.

Mechanical mitral prosthetic thrombosis in a 52-year-old marfan woman associated with COVID-19 infection

Patients with coronavirus disease 2019 (COVID-19) may present a hypercoagulable state, which can lead to thrombotic manifestations. We present a case of mechanical mitral valve thrombosis and a large thrombus in the left atrium after COVID-19 infection in a 52-year-old Marfan woman.

Case report: Mechanical mitral prosthetic valve thrombosis in the context of COVID-19 despite effective anticoagulation

BackgroundThe SARS-CoV2 virus has been an emerging virus since December 2019 and is the cause of a global pandemic whose clinical manifestations extend far beyond respiratory disease.Case summaryA patient with severe coronavirus disease 2019 respiratory infection, carrying a mechanical mitral valve and under anticoagulation, was admitted to our cardiology department because of a new atrial fibrillation, which turned out to be related to thrombosis of the mitral mechanical valve.ConclusionThe pro-coagulant effect of the SARS-CoV2 virus does not spare patients at risk of thrombosis, even under effective anticoagulation. In patients with mechanical valves under vitamin K antagonist treatment, there is a high risk of thrombus formation. The treatment is based on thrombolysis by therapeutic anticoagulation, fibrinolysis, or surgery depending on the size, composition of thrombus, and clinical manifestation.

A South Africa tertiary centre experience with redo mitral valve replacement

Severe cardiac failure from mechanical mitral valve thrombosis due to poor warfarin control is a major cause of emergency redo mitral valve replacement (MVR) in South Africa. This study aimed to review the outcomes of redo MVR in patients presenting with mitral valve failure to a tertiary South African centre.Retrospective chart review of patients undergoing redo MVR over a 10-year period (2005-2014). Patient demographics, aetiology of valve dysfunction, preoperative clinical assessment and outcomes were analysed.Sixty-four patients had 80 mitral valve procedures. The M:F ratio was 1:2.8 and the median age was 18 (IQR 14-28.5) and 25 (IQR 18-40) at initial surgery and at redo surgery, respectively. Median interval between original and redo MVRs was 47.5 (IQR 7.5-124) months. Rheumatic valve disease was the original pathology in 58 patients (90.6%). Fifty-two patients underwent a single redo MVR and 12 patients had multiple redo MVRs. Fifty-eight (72.5%) were emergency redo procedures. Prosthetic valve thrombosis was present in 73.8%. Ten patients (15.6%) developed postoperative complications. The median hospital stay and ICU stay were 19 (IQR 12-27.5) days and 4 (IQR 3-7) days, respectively. Two patients died in the postoperative period (3.1%). The mean patient follow-up was 42 months. Three patients died during follow-up.The majority of redo MVR procedures were undertaken as an emergency with valve thrombosis being the most common aetiology. The mortality rate was 3.1% and postoperative complication rate was 15.6%.

Thrombolysis Versus Redo-Surgery for Treatment of Mechanical Prosthetic Mitral Valve Thrombosis in Young Adult Patients

Abstract Objectives To evaluate and compare outcome of redo-surgery and thrombolysis for treatment of mitral PVT following mechanical valve replacement for rheumatic etiology in young adult patients (<50 years old). Methods and Results This retrospective study included 42 young adult patients who had PVT after mechanical valve replacement for rheumatic mitral valve disease, between January 2014 and June 2019. Eighteen patients underwent redo-surgery and 24 patients underwent thrombolysis (Streptokinase 100,000 U/h for at least 24 hours). The approach of treatment was based on proposed criteria considering hemodynamic status, NYHA functional class, and thrombus size. Complete response to thrombolysis was defined by normal clinical and echocardiographic parameters. Primary outcome included response to thrombolysis, complications, mortality, and recurrence. The median follow-up period was 24 months. The thrombus size was significantly larger in redo-surgery group (9.88±2.44 mm2 vs 5.87±1.26 mm2, P < 0.001). The response to thrombolysis was complete recovery (70.8%), partial recovery (16.7%), or failure (12.5%). There was no significant difference in the incidence of major complications. Mortality was significantly higher in redo-surgery group (27.8% vs 4.2%, P = 0.03), with cumulative survival of 72.2% for redo-surgery versus 95.8% for thrombolysis (Log-rank P-value = 0.04). The reduced cumulative survival with redo-surgery was more evident in patients with delayed presentation (> 1 week). Recurrent thrombosis occurred only with thrombolysis (8.3% vs 0%, P = 0.20). Cumulative proportions for freedom from thrombosis were 100% for surgery versus 78.1% for thrombolysis (Log-rank P-value = 0.17). Conclusions Proper patient selection may improve outcome after treatment of mitral PVT using thrombolysis or redo-surgery in young adults. Redo-surgery has advantages over thrombolysis regarding mid-term recurrence of thrombosis; however, thrombolysis has significantly lower mortality than redo-surgery. Further evaluation of the proper treatment for delayed presentation of PVT is recommended.

Mechanical Mitral Valve Thrombosis Treated With Fibrinolysis

A 27-year-old lady presented to the emergency department with a 3-week history of worsening shortness of breath. Her past history was significant for mechanical mitral valve replacement 6 months prior for rheumatic mitral stenosis. She had recently been non-compliant with international normalised ratio checks for warfarin dosing in the setting of local lockdown for the COVID-19 pandemic. On examination, there was loss of mitral valve click with associated elevated jugular venous pressure, right ventricular heave, loud P2, and bi-basal crepitations.

Management of Valvular Heart Failure Due To Mechanical Mitral Valve Thrombosis During Pregnancy

Background Mechanical heart valves may pose hemodynamic challenges leading to significant heart failure during pregnancy, especially if thrombosis or stenosis occurs. On the other hand, warfarin can have teratogenic effects, and expectant mothers may try to avoid it during pregnancy. Case A 38-year-old woman with 30-week pregnancy complained of progressive dyspnea on minimal exertion. She had a history of congenital mitral valve abnormality for which had undergone mechanical valve replacement 21 years prior, with subsequent mechanical valve thrombosis after she held her warfarin for several days during a previous pregnancy which was treated successfully with tissue plasminogen activator (tPA). The patient's anticoagulation had been changed to enoxaparin from weeks 7 to 12 to decrease the risk of teratogenesis. Her international normalized ratio (INR) remained therapeutic afterwards, so her mildly elevated mean mitral gradient (MMG) was initially attributed to increased cardiac output of pregnancy. However, as her dyspnea worsened, concerns for thrombosis increased. She underwent transthoracic echocardiography (TTE) which evidenced that her MMG had increased from 12 to 20-22 mmHg over the last 3 months prior to presentation, with no decrease in her right or left ventricular systolic functions. Fluoroscopy and transesophageal echocardiography (TEE) showed no anterior leaflet mobility. She was admitted to the cardiovascular critical care unit where she received tPA infusion for 24 hours with subsequent TTE evaluation. Although the MMG normalized, there was still residual leaflet restriction. Fibrinolytics were continued for a total of 48 hours, and she was bridged to warfarin with heparin (goal partial thromboplastin time [PTT] 2-2.5 of control range). Her INR goal range was increased to 3-4. She underwent cesarean section and tubal ligation at 34 weeks of pregnancy. Neither she nor her baby had complications. Conclusion This case supports the cautious use of fibrinolysis in pregnant patients presenting with progressive heart failure secondary to mechanical valve thrombosis under intensive, multi-disciplinary monitoring by cardiologist and maternofetal medicine specialists.

MECHANICAL MITRAL VALVE THROMBOSIS AND THROMBOLYSIS WITH ALTEPLASE IN A SURGICAL HIGH RISK PATIENT

Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses We present a 30 years-old woman with a history of rheumatic heart disease that required valvular replacement surgery at an early age with poor adherence to

Successful Thrombolytic Treatment of a Thrombosed Mechanical Mitral Valve in a Post-brain Surgery Patient- A Case Report and Literature Review

The first-line management of prosthetic valve thrombosis is not yet finalized; dealing with such cases remains a clinical challenge and requires prompt detection, timely diagnosis and individualized case management regardless of whether the case in question requires a surgical or medical therapeutic approach. We report a unique case of mechanical mitral valve thrombosis post Bentall procedure with a double aortic-mitral valve replacement in a patient who previously underwent brain surgery after experiencing a Road Traffic Accident (RTA). The patient was successfully treated by using a combined loading and infusion regimen of tissue-Plasminogen Activators (t-PA). A small loading dose of 15 mg followed by a low-dose slow infusion of t-PA has been shown to provide effective and safe thrombolysis in high-risk patients with prosthetic valve thrombosis.

The predictive value of the CHA2DS2-VASc score in patients with mechanical mitral valve thrombosis.

Prosthetic valve thrombosis (PVT) is a potentially life-threatening complication associated with high morbidity and mortality. The CHA2DS2-VASc is a clinical score used to determine thromboembolism risk in non-valvular atrial fibrillation patients. Therefore; in this study, we aimed to determine predictive value of the CHA2DS2-VASc score for development of PVT in patients with mechanical prosthetic valve. This was a retrospective study included 417 consecutive patients with mechanic prosthetic valve in whom transesophageal echocardiography (TEE) was performed due to different clinical indications from January 2004 to June 2016. After evaluation according to exclusion criteria, 267 patients with mechanic prosthetic valve were enrolled in the study. The definitive diagnosis of the PVT was made as proposed by TEE finding. The study population was divided into two groups; PVT patients (154 patients) and control group (113 patients) with functional prosthetic valve. The CHA2DS2-VASc score was calculated for each patient from the hospital electronic database. The mechanical mitral valve thrombosis predictive value of variables including CHA2DS2-VASc score was tested in our study. The mean CHA2DS2-VASc score was significantly higher in PVT patients compared to control patients (2.51 ± 1.54 vs. 1.13 ± 1.21, p < 0.01). Both on univariate and multivariate analysis demonstrated that the CHA2DS2-VASc score is independently associated with PVT (p < 0.001 and p < 0.001, respectively). The patients whose CHA2DS2-VASc score ≥ 1-3 had 6.20 times higher risk for thrombus formation, and patients whose CHA2DS2-VASc score ≥ 4 had 16.6 times higher risk for thrombus formation compared to patients with CHA2DS2-VASc score = 0 (p < 0.001 and p < 0.001, respectively). The CHA2DS2-VASc score may be a significant independent predictor of PVT in patients with prosthetic valve and the CHA2DS2-VASc score ≥ 2.5 or more was associated with increased PVT in patients with prosthetic valve. Thus; it may be an applicable risk scoring system to assess the risk of development of PVT in patients with prosthetic valve.

A Therapeutic Challenge: Management of Atrial Thrombus

Introduction: Primary cause of atrial thrombi include atrial fibrillation, foreign bodies inside the atrium such as catheters and pacemaker leads, emboli of deep venous thrombus and primary or metastatic tumors of the heart. We review the clinical features, epidemiology, diagnosis and treatment of nine intriguing cases with atrial thrombus. Methods: This is a retrospective study of nine patients (seven female (78%), two male (33%)) who were diagnosed with atrial thrombi (average age of 50 ± 12 years) and were treated at the Ondokuz Mayis University, Department of Cardiovascular Surgery from February 2014 to January 2015. Among them, six patients had atrial fibrillation (one male, five female), seven patients were suffering from dispne and orthopnoea, five patients were suffering from leg swelling, seven patients had a history of hypertension and three patients had a history of mitral valve replacement surgery. Results: All patients underwent surgery except one. Four patients recovered uneventfully and discharged with oral anticoagulation (warfarin) therapy (adjusted to maintain an international normalized ratio of INR between two and three times). Five of nine patients (55%) died after surgery. Conclusion: The response to the thrombolytic therapy is poor, mostly ineffective and unsafe so it is often recommended as a bridge to surgery. In patients diagnosed with mechanical mitral valve thrombosis, medical therapy has the possibility of end organ emboli and also fail to resolve the organised thrombus on the stuck valve. On the other hand surgery does not always give satisfactory results. J Clin Exp Invest 2016; 7(4): 278-282

Acute Prosthetic Mechanical Mitral Valve Thrombosis Following Open Cholecystectomy

Acute Prosthetic Mechanical Mitral Valve Thrombosis Following Open Cholecystectomy

Management of Acute Mechanical Mitral Valve Thrombosis With Venoarterial Extracorporeal Membrane Oxygenation (ECMO)

MECHANICAL PROSTHETIC VALVE THROMBOSIS (PVT) and obstruction is a life-threatening event. Due to the associated progressive presentation of heart failure symptoms and often frequent delay in diagnosis, a high mortality rate has been described.1 In addition, surgical intervention in this setting has been associated with high perioperative risk for poor outcome that directly correlates with the degree of hemodynamic instability and a higher New York Heart Association functional class on presentation.

ACUTE PROSTHETIC MECHANICAL MITRAL VALVE THROMBOSIS: NEEDLE OR SCALPEL?

Surgery is the treatment of choice for prosthetic mechanical mitral valve thrombosis (PMVT) with heart failure. We present a case where two-dose thrombolysis was successful in PMVT. A 35-year-old woman with history of mechanical mitral valve for rheumatic mitral stenosis presented with dyspnea,

Results of surgical management in mechanical mitral valve thrombosis

Valve thrombosis is a serious complication of heart valve surgery. It most often involves mechanical valve in mitral position and may be life-threatening in the short term period, necessitating prompt treatment. Among therapeutic options, surgery leads to complete success of deobstruction but with a high morbi-mortality rate.

The Incremental Value of RT Three‐Dimensional TEE in the Evaluation of Prosthetic Mitral Valve Ring Thrombosis Complicated with Thromboembolism

Although nonobstructive prosthetic valve thrombosis (PVT) does not develop hemodynamic compromise, it carries potential risk for thromboembolism. Real time three-dimensional transesophageal echocardiography (RT-3DTEE), has emerged as a complementary tool in depicting "en face" views of prosthesis compared with two-dimensional transesophageal echocardiography (2DTEE). We aimed to evaluate the utility of RT-3DTEE in assessment of mitral ring-located thrombosis. We present 3 cases of mechanical mitral valve thrombosis complicated by thromboembolism, who were all examined and followed-up by 2D transthoracic echocardiography (TTE), 2DTEE, and RT-3DTEE. The consequencies of thromboembolism in the patients were coronary embolism, transient ischemic attack, and ischemic stroke, respectively. They were all inadequately anticoagulated at the time of admission. 2DTTE and TEE examination was unsatisfactory; RT-3DTEE depicted nonobstructive mitral ring thrombosis in each of the patients. The patients were followed up under effective anticoagulation and antiplatelet therapy. RT-3DTEE was able to demonstrate the evolution of thrombus size in each of the patients. Nonobstructive ring-located PVT which poses risk for thromboembolism, may be diagnosed with certainty and imaged with clarity utilizing RT-3DTEE.