Prosthetic Aortic Valve Replacement Research Articles

Dilatation and Dysfunction of the Neo-aortic Root and in 76 Patients After the Ross Procedure.

Pulmonary autograft replacement (Ross procedure) is used as an alternative to prosthetic aortic valve replacement patients with aortic valve disease. There are limited data on incidence and risk factors for dilatation and dysfunction of the neo-aortic after the Ross procedure. Ross procedure was performed in 100 patients at our institution between 1993 and 2011. In 76 patients, complete follow-up data were available. Their median age at surgery was 16 (0.4-58) years (76% males; 95% with congenital aortic valve disease). Median follow-up duration was 5.2years (0.3-16.0years). We analyzed their clinical and echocardiographic follow-up to identify possible risk factors for neo-aortic root dilatation and dysfunction. Ross procedure included reduction plasty of the native ascending aorta in 25% of patients. During follow-up, 21 patients (28%) developed neo-aortic root dilatation, 38 patients (50%) dilatation oft the native ascending aorta and 7 patients (9%) at least moderate neo-aortic regurgitation. Univariate risk factors for neo-aortic root dilatation were preoperative aortic regurgitation (p=0.04), concomitant reduction plasty of the ascending aorta (p=0.009) and a longer duration of follow-up (p=0.005). Younger age at surgery was associated with dilatation of the ascending aorta (p=0.03). Reoperation on the neo-aortic root because of severe dilatation was necessary in 6 patients (8%), where 2 patients had at least moderate neo-aortic root regurgitation. Neo-aortic root and aortic dilatation are common after the Ross procedure. This is often combined with neo-aortic valve dysfunction. Close follow-up of these patients is mandatory.

EFFICACY OF ANTICOAGULATION IN PREVENTING THROMBOEMBOLISM AFTER BIO PROSTHETIC AORTIC VALVE REPLACEMENT: A META-ANALYSIS

The efficacy of oral anticoagulation (AC) after bio prosthetic aortic valve replacement (BPAVR) remains unclear. Current guidelines recommend AC for first three months after BPAVR, but there is significant variation in clinical practice. We performed a meta-analysis of studies comparing AC to

Catheter-based closure of paravalvular leaks: "Plug the hole"

Paravalvular leak (PVL) is a relatively rare, but serious complication occurring in up to 10% of patients after prosthetic aortic valve replacement and in up to 17% of patients after prosthetic mitral valve replacement. Up to 5% of patients will present with symptoms of congestive heart failure or mechanical haemolytic anaemia due to PVL and need further surgical or interventional treatment. Surgical repair is often technically challenging and carries a high mortality and morbidity risk. Catheter-based closure of PVL has emerged as an alternative approach especially for patients with relevant comorbidities at high surgical risk. Interventional closure of PVL is a complex procedure, which needs to be performed by an experienced team of interventional cardiologist, echocardiographer and anesthesiologist. To date available clinical results are promising showing low complication rates and high technical or clinical success rates of catheter-based closure of PVL (60-90%). Compared to surgical closure of PVL lower mortality rates (30-days mortality rate: 4,6%) have been documented in patients treated by catheter-based closure of PVL in clinical practice. Therefore interventional closure seems to be a promising option, which need to be discussed with every symptomatic patient suffering from PVL prior to therapeutical decision making. To date only sparse clinical data is available regarding indication and clinical outcome of patients undergoing catheter-based PVL in clinical practice. Therefore interventional closure of PVL should be limited to experienced interventional cardiologist at present. All patients treated should further be enrolled into a clinical registry to evaluate the safety and efficacy of catheter-based closure of PVL in clinical practice.

Aorto-right ventricular fistula: An early complication of aortic valve replacement

The implantation of prosthetic heart valves has been associated with several kinds of complications, but the description of aorto-right ventricle (ARV) fistula as a complication of aortic valve replacement is a very rare finding. We report herein the case of a 56-year-old woman sought care for palpitations two months after prosthetic aortic and mitral valve replacement. Cardiac examination revealed normally audible mechanical sounds with a new loud to-and-fro murmur with continuous precordial thrill. Thyroid function tests were poorly balanced (raised FT4 and lowered TSH). Electrocardiography at admission displayed rapid heart rhythm with atrial fibrillation. Trans-thoracic echocardiography (TTE) revealed left-to-right shunt due to aorto-RV fistula. We discuss then the aetiology, diagnosis and management of this rare para-valvular leakage.

Intramyocardial Dissection following Postinfarction Ventricular Wall Rupture Contained by Surrounding Postoperative Adhesions.

Introduction. Dissection of the myocardium is a rare form of cardiac rupture, caused by a hemorrhagic dissection among the spiral myocardial fibers, its diagnosis is rarely established before the operation or death, and extremely few cases have been reported in the literature and none of these cases seem to have a history of previous cardiac surgery which makes our report unique. Case Presentation. A 61-year-old female patient was admitted into the emergency room with complaints of progressive chest pain for 2 days. She had a history of second time prosthetic aortic valve replacement and was under anticoagulation therapy. She was diagnosed with an acute inferoposterior myocardial infarction and underwent emergency coronary angiography revealing spontaneous recanalization of the right coronary artery. During the follow-up, she developed cardiogenic shock and a new occurring systolic ejection murmur. Transthoracic echocardiography showed a left ventricular free wall rupture; then, she was taken in for emergency surgery. During the operation, a rupture zone and a wide intramyocardial dissecting area were detected. Intraventricular patch repair technic with autologous pericardial patch was used to exclude the ruptured area. Following the warming period, despite adequate hemostasis, hemorrhage around suture lines progressively increased, leading to the patient's death. Conclusion. Pericardial adhesions might contain left ventricular rupture leading to intramyocardial dissection.

PROSTHESIS-PATIENT MISMATCH IN VALVULAR HEART DISEASE: AN EVALUATION OF ECHOCARDIOGRAPHIC FINDINGS

Guidelines for reporting echocardiographic studies in prosthetic heart valve patients have recently been published. Prothesis-patient mismatch (PPM) was first described in 1978 and is present when the effective orifice area (EOA) of an implanted surgical prosthetic valve is too small in relation to a patient’s body surface area (BSA). PPM remains a common occurrence and has been reported in the literature in up to 20-70% of AVR patients. This is concerning, since undersized prostheses relative to body size may result in higher transprosthetic gradients, worse hemodynamic function and adverse patient outcomes. We examined reporting trends in patients with prosthetic aortic and mitral valves at London Health Sciences Centre (LHSC)and St Joseph's Health Care, with particular focus on PPM in these patient populations. Patients with prosthetic aortic valve replacement (AVR) and/or mitral valve replacement (MVR) undergoing echocardiography between September 2003 and August 2013 were identified. Studies with complete patient data for whom PPM could be measured were included for further analysis. PPM was defined as EOA/BSA ≤ 0.85 cm2/m2 in the aortic position (0.65-0.85 cm2/m2 moderate, <0.65 cm2/m2 severe), and as ≤ 1.3 cm2/m2 in the mitral position. Demographic and echocardiographic parameters were evaluated. Overall 8901 studies from 3378 patients were identified (61% male; mean age 68 ± 13 years). Echocardiographic studies (mean 2.6 studies/patient) were performed in patients with AVR (6290, 71%), MVR (1904, 21%) or both (707, 8%). Complete data sets were obtained for 2391 AVR studies. PPM was present in 44% of AVR studies (severe in 3%). AVR patients with PPM were older at the time of valve replacement (71 vs. 63 years) and at follow-up (73 vs. 65 years), had greater body weight (86 vs. 81kg), larger BSA (1.97 vs. 1.92kg/m2), smaller left ventricular dimensions (47 vs. 49mm), LVOT (19 vs. 20mm) and aortic roots (30 vs. 32mm), with higher transprosthetic gradients (34 vs. 26mmHg) and lower Doppler velocity index (0.41 vs. 0.44) in comparison to patients without PPM (p<0.001 for all). PPM was more common in females (48% vs. 41%, p=0.002), in those with bioprosthetic AVR (56% vs. 9%, p<0.001), with concurrent CABG (52% vs. 39%, p<0.001) and without concurrent aortic root enlargement surgery (46% vs. 32%, p<0.001). The presence of PPM in AVR patients in our study population was common. Our data analysis identified patient subsets with a higher prevalence of PPM, which co-localized with indices of impaired cardiac performance.

Posterior nutcracker syndrome: an infrequent cause of hematuria

A 44-year-old man presented to the hospital with gross hematuria and left flank pain. His relevant medical history included Marfan syndrome, a DeBakey type 1 aortic dissection repair, and St Jude’s prosthetic aortic valve replacement in 2008 requiring chronic anticoagulation with warfarin. International normalized ratio was 2.9 on admission and warfarin was discontinued. A contrast-enhanced computed tomography scanning of the abdomen and pelvis demonstrated blood in the left renal pelvis. The dissection extended into abdominal aorta, which was dilated. There was symmetric perfusion of both kidneys without evidence of mass or calculus. A prominent left renal vein was noted with a compressed, retroaortic communication with the azygos vein (Figure 1). There was also an anomalous communication between the azygos vein and the inferior vena cava. Urine culture was negative. Cystoscopy showed blood clots in the left collecting system without evidence of malignancy. The patient’s hematuria continued while receiving intravenous heparin. A left renal arteriogram was normal. A selective left renal venogram confirmed extrinsic compression at the aorta with an elevated venous gradient of 6 mm Hg. The left retroaortic renal vein was primarily stented with a 10 by 37 mm biliary express balloon expandable stent with correction of compression and resolution of venous pressure gradient (Figure 2). The hematuria resolved and had not recurred with reinitiating warfarin therapy.

Ross-Konno Procedure for the Surgical Treatment of Prosthesis-Patient Mismatch After Prosthetic Aortic Valve Replacement

The Ross-Konno procedure has become a widely recognized surgical method for the treatment of complex left ventricular outflow tract obstruction (LVOTO) in patients of younger age. We applied this method in two young females who presented following mechanical aortic valve replacement with severe prosthesis-patient mismatch (PPM) resulting in significant gradient across the left ventricular outflow tract and congestive heart failure. In both cases the postoperative course was uneventful with immediate improvement in clinical symptoms. Both patients remain in excellent clinical and hemodynamic condition four and six years after the Ross-Konno procedure.

Repair of the Regurgitant Bicuspid or Tricuspid Aortic Valve

The treatment of severe aortic valve regurgitation (AR) has been moving ahead quickly and has undergone a fundamental transition over the past few decades. Mechanical or bioprosthetic aortic valve replacement has been the standard of care for many years for most types of AR. Although still restricted to patients with well-defined pathological aortic valve and root anatomy, the number of accepted indications for reconstructive aortic valve surgery is growing. The cusp tissue, aortic annulus, tissue of the sinus of Valsalva, commissures, subcommissural tissue, and sinotubular junction constitute the functional unit of what is generally called the aortic root. Reconstructive surgery for severe aortic valve insufficiency today includes a wide variety of procedures on all of those components, from simple cusp plication to complex valve-sparing aortic root replacement (V-SARR). It is ultimately aimed not only at improving symptoms of congestive heart failure and increasing life expectancy but also at giving the patient a chance to live a normal life because it renders lifelong anticoagulation unnecessary. V-SARR procedures have recently been discussed not only as adequate correction for aneurysms but even as supplementary procedures to prolong the longevity of a valve repair. Our article gives an overview of the background and principles of reconstructive aortic valve procedures for AR in the setting of both a bicuspid and a tricuspid aortic valve. It explains the principles, describes the techniques, and reviews the reported current outcomes after reconstruction of the different components of the aortic root. This overview should help clinicians evaluate the status and relevance of frequently discussed current techniques for the treatment of patients with different types of thoracic aortic aneurysms and AR. The need for lifelong anticoagulation remains the main drawback of prosthetic aortic valve replacement for many young patients living an active lifestyle. In addition to sparing the patient’s native …

De-novo construction of the aortic valve using glutaraldehyde-treated autologous pericardium: An old concept revived

Objective: The related limitations and complications of prosthetic aortic valve replacement, due to life-long anticoagulation or early tissue degeneration let us to revive the technique of de-novo aortic valve construction from glutaraldehyde-treated autologous pericardium. The objective of this study was to evaluate the early clinical and hemodynamic outcome after this surgical treatment.

Idiopathic left ventricular outflow tract pseudoaneurysm

Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare occurrence and may produce clinically unpredictable symptoms. A very few cases of LVOT pseudoaneurysm are reported and there has always been a predisposing factor in these reported cases such as history of infective endocarditis, myocardial infarction, prosthetic aortic valve replacement or chest trauma. Our patient did not have the above predisposing conditions. Intra operative transesophageal echocardiography helped patient management and guided the surgical team in securing and isolation of the aneurysmal sac from the LVOT.

306: Pregnancy Following Aortic Valve Replacement - Cardiac, Maternal and Fetal Outcomes

The choice of aortic valve substitute in young women should take the desire for pregnancy into account. Currently however, little is known about pregnancy-related outcomes following aortic valve replacement (AVR). The aim of this study was to assess cardiac, maternal and fetal-related outcomes in female patients with AVR during and after pregnancy. A retrospective study of all AVRs performed in women under the age of 40 years at our institution was undertaken. These patients were prospectively followed at our dedicated valve clinic. Patients with Turner syndrome or having undergone a hysterectomy and/or tubal ligation were excluded. Cardiovascular, maternal and fetal outcomes were gathered from medical records and telephone interviews. From 1976 to 2011, 77 women underwent 86 isolated AVRs: 65 mechanical prostheses (MPs) and 21 bioprostheses (BPs). The follow-up was 81% complete. Ten patients (13%) had 19 pregnancies at a mean age of 28±6 years. Of those, 5 ended in miscarriages (26%; n=4 BPs and n=1 MPs). Twelve (63%) pregnancies occurred in patients with BPs. The following adverse events were reported: two hospitalizations for syncope (25%), functional prosthetic valve deterioration during pregnancy necessitating reintervention 6 months post-partum (12%) and 4 miscarriages (33%). Nine of the 65 women (14%) with MPs had a hysterectomy or endometrial ablation for excessive uterine bleeding, precluding childbearing potential. In total, 7 pregnancies were reported in women with MPs. Two of them were terminated (n=1, medical advice and n=1 embolic myocardial infarction). The following peri-partum complications occurred: two embolic myocardial infarctions (33%), a postpartum bleeding (16%) and an urgent caesarean for placental abruption (16%). No fetal adverse events were observed. Findings from this study suggest that pregnancy in women with prosthetic AVR is associated with an increased risk of cardiac adverse outcomes.

A Rare complication of aorto-left atrial fistula after aortic valve replacement and its management with intraoperative transoesophageal echocardiography

Aorto-atrial fistula is a rare complication of prosthetic aortic valve replacement and most of them have been diagnosed as a late complication. We present a case of this unusual complication after aortic valve replacement which was diagnosed intraoperatively and this potentially disastrous complication was corrected promptly. Early recognition and diagnosis of this rare surgical complication with intraoperative transoesophageal echocardiography (TEE) is imperative for prompt surgical repair of this lethal defect.

Gerbode-type left ventricular outflow tract to right atrial fistula complicating prosthetic aortic valve replacement identified by cardiac computed tomographic angiography

Acquired left ventricular-right atrial communication ( Gerbode-type defect) is a rare complication of infective endocarditis. Although transesophageal echocardiography remains the technique of choice for the evaluation of complications of endocarditis this case highlights the usefulness of cardiac computed tomography in this scenario, particularly in cases where assessment of coronary anatomy is required before surgery.

Aorto–right Ventricular Fistula: A Complication of Aortic Valve Replacement

The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-year-old woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula.

Multiple Time Aortic Valve Replacement

A 32-year-old female who had undergone aortic valve replacement (AVR) 10 years previously as a result of an episode of infective endocarditis with the pathogen Staphylococcus epidermidis, was admitted to the hospital with a history of appetite loss, chilling, relapsing fever up to 39℃, and left leg pain. Her medical history included Williams syndrome along with patch aortoplasty and aortic valve commissuroplasty 22 years earlier when she was 10 years old. The patient was lost to follow-up until age 16, when she was readmitted with native valve endocarditis. She was treated with AVR with a 21-mm CarboMedics mechanical valve (CarboMedics, Inc., Sorin Group, Burnaby, British Columbia, Canada) and graft interposition of the ascending aorta with a 20-mm Hemashield artificial graft (Maquet Cardiovascular, Wayne, NJ). She was again lost to follow-up until age 22, when she stayed the hospital again for a week with a fever. She underwent redo AVR again with a 21 mm Edwards MIRA mechanical valve (Edwards Lifesciences, Irvine, CA, USA). She was discharged December 15, 2000, and was prescribed a regimen of an anticoagulant, but the patient has not taken any warfarin since. However, she became pregnant twice and had an abortion and a birth without anticoagulation during this period. The blood culture yielded growth of Staphylococcus sanguis, which was sensitive to the initial treatment regimen. Immediate transthoracic echocardiography and transesophageal echocardiography demonstrated vegetations (0.75×0.2 and 0.8×0.3 cm linear oscillating masses), which were observed on the left ventricular side of the prosthetic aortic valve (Fig. 1). The increased infection parameters, including fever, leukocytosis, and ESR, and the blood culture again showed the presence of Staphylococcus sanguis and a sensitivity to ceftriaxone, so the treatment was continued. However, a linear oscillating mass at the prosthetic aortic valve was observed despite the clinical control of the infection. Consequently, re-redo AVR was performed with a 25-mm St. Jude mechanical valve on the 25th day after the initiation of antibiotic treatment. Following successful surgery, the patient recovered well and was discharged after six weeks of postoperative antibiotic treatment without any signs of infective endocarditis. Fig. 1 Vegetations (arrow) were observed at the left ventricular side of the prosthetic aortic valve and aortic regurgitation was seen by TEE. LV=left ventricle; LA=Left atrium; AV=Aortic valve (arrow head); Ao=Aorta. In spite of advances in medical and surgical treatment, infective endocarditis is still regarded as a serious disease [1]. Patients with previous infective endocarditis are considered at high risk of recurrent endocarditis, so significant attention should be paid to prevent any recurrences [2-5]. A large number of female patients with valvular heart disease will be of childbearing age at some point. This case shows a serious complication concerning a pregnant patient with prosthetic heart valves. Also, this patient was uncooperative with our treatment, and had low social standingswithout the benefit of formal education. In this case, prosthetic aortic valve replacement was performed during the second episode of infective endocarditis, and the patient was three months pregnant when she was admitted to the hospital with a history of fever for a week. She should have taken warfarin diligently and gone for regular check-ups to prevent a third infection. However, she discontinued anticoagulant medication and follow-up examination as an outpatient. As a result, she needed an abortion in order to undergo re-redo aortic valve replacement due to the second episode of endocarditis. Consequently, patients with prosthetic valves should be sufficiently educated about infective endocarditis before discharge, and preventive measures, such as effective personal hygiene, should be prescribed.

Elective edentulation after 7 episodes of infective endocarditis: A clinical report

aResident, Prosthodontics & Maxillofacial Prosthetics, Division of Prosthetic and Esthetic Dentistry. bAssociate Professor, College of Medicine, Division of Prosthetic and Esthetic Dentistry. cProfessor, College of Medicine, Chair, Division of Prosthetic and Esthetic Dentistry. (J Prosthet Dent 2011;106:1-5) A 3-year clinical follow-up is presented of a patient who underwent elective extraction of the remaining natural dentition, followed by rehabilitation with maxillary and mandibular complete dentures after 7 documented episodes of infective endocarditis. The patient was diagnosed with congenital ventricular septal and valvular defect and was treated in 1984 with a prosthetic aortic valve replacement secondary to idiopathic infective endocarditis due to Haemophilus influenzae. From 1984 to 2007, the patient experienced 7 episodes of infective endocarditis associated with various microorganisms, all of oral flora origin. In the 3 years after elective extraction of the remaining natural dentition, the patient had not experienced any episodes of infective endocarditis. In light of recent changes and controversy in the recommendations for the prevention of bacterial endocarditis, the question arises as to whether the efforts of dental providers to maintain the dentition of high risk patients outweighs the associated increased risks of morbidity and mortality. While the guidelines attempt to assist health care providers in clinical decision making, there are certain instances where a patient-centered approach necessitates alternative options.

Life-threatening bleeding under vitamin K antagonists in spite of an INR in the therapeutic range

The major risk associated with the use of vitamin K antagonists (VKA) is haemorrhage, which might be severe or even life-threatening. In clinical studies where anticoagulation intensity was carefully monitored, treatment with VKA increases the risk of major bleeding by 0.3-0.5% per year when compared to controls [1]. In randomized trials including patients with mechanical heart valves, VKA treatment was associated with a risk of major bleeding ranging between 1 and 8.3% [1]. However, in clinical practice, the rates are less consistent [1]. The major determinants of VKA-induced bleeding are the intensity of the anticoagulant effect, the patient characteristics, the concomitant use of drugs that interfere with hemostasis, and the length of therapy [1]. Here, we report a case of a rare hypersensitivity to VKA due to a mutation of factor IX (FIX) propeptide in the context of a prosthetic mechanical heart valve. In November, 2008, a 62-year-old man presented with an obstructive laryngeal hematoma (Fig. la, b) after tongue biting requiring intratracheal intubation. His medical history revealed prosthetic mechanical aortic valve replacement in July 2008 (Bentall procedure, Cardiomedic prosthesis). Oral anticoagulation with VKA (acenocoumarol) was initiated post-operatively. When the laryngeal hematoma appeared, the patient's International Normalized Ratio (INR) was 3.5. In December, 2008, the patient was admitted to the intensive care unit with a massive hemothorax (Fig. 1c) occurring 10 days after a reintervention to cure a paraprosthetic leak, and requiring surgical drainage. INR was 1.3. The patient's and his relatives reported no history of bleeding. Aspirin, the only patient's medication favoring bleeding, had been stopped 4 days before the first bleeding episode. Before the introduction of acenocoumarol, blood count, prothrombin time (PT) and activated partial thromboplastin time (APTT) were within the normal range. Coagulation tests are listed in Fig. 1d. Both major bleeding episodes were accompanied by INR values within or even below the therapeutic range (therapeutic range for a mechanical valve carrier: 2.5-3.5) [2]. However, APTT was abnormally prolonged because FIX was exaggeratedly lower than the other vitamin K dependant factors (II, VII, X). Factor V, VIII, XI and XII were within the normal range during both bleeding episodes. APTT and FIX both normalized after vitamin K supplementation and bleeding did not recur. Genomic DNA was purified from the patient whole blood, and FIX exon 2 was amplified using the forward primer 5'-catgccctaaagagaaattggct-3' and the reverse primer 5'-tgcatctgaagggtattatgtgg-3'. The thermocycling conditions of the PCR were 30 s 94°C, 1 min 53°C, and 1 min 72°C, for 40 cycles. Direct sequencing of the PCR product showed a single guanosine-to-adenosine transition at nucleotide 109 (numbered from genBank accession gi180552) causing the substitution of alanine at locus-10 (Ala-10) by threonine in the FIX propeptide (Fig. 2a).

Prosthetic Aortic Valve Stenosis in End-Stage Renal Failure

Although renal failure is one of the known comorbidities associated with rapid progression of aortic stenosis, it is unclear whether hemodialysis alters the progression of prosthetic aortic valve stenosis. We describe a 79-year-old female who underwent bioprosthetic aortic valve replacement 8 years ago with stable prosthetic valve area for the initial 6 years. In the last two years, coinciding with the initiation of maintenance hemodialysis, she developed progressive prosthetic valve stenosis to the point of clinical decompensation. She underwent a second prosthetic aortic valve replacement with symptom resolution. This case suggests that circulating milieu in end-stage renal failure and dialysis can accelerate the progression of prosthetic aortic valve stenosis. More frequent clinical followup and surveillance echocardiogram for dialysis patients with bioprosthetic aortic valve may facilitate timely management of valvular stenosis.

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

: 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. : 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. : 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. : 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.