Stuck Valve Research Articles

Anticoagulant therapy in pregnant women with mechanical and bioprosthetic heart valves.

The aim of the present study was to review maternal and fetal outcomes in pregnant women with prosthetic heart valves. A retrospective record review of pregnant women with prosthetic heart valves on anticoagulation was performed at the Specialist Cardiac Antenatal Clinic, Johannesburg South Africa from 2015 to 2023. Fifty pregnancies with mechanical heart valves and three with tissue valves, on anticoagulation for comorbid atrial fibrillation were identified. The majority were of African ethnicity at a mean age of 33 ± 6 years. Anti-Xa adjusted enoxaparin was commenced at 10.5 ± 5.6 weeks' gestation until delivery in 48 (90.6%) pregnancies and warfarin was continued in five (9.4%) pregnancies. The live birth rates on enoxaparin and warfarin were 56.3% (95% confidence interval [CI]: 42.3-69.3) and 20.0% (95% CI: 2.0-64.0), respectively. There were 12 (22.6%) miscarriages at a mean of 11.3 ± 3.7 weeks' gestation, four (7.5%) intrauterine fetal deaths on warfarin and two (3.8%) warfarin embryopathy/fetopathy. The rates of antepartum/secondary postpartum bleeding and primary postpartum bleeding were 29.4% (95% CI: 18.6-43.1) and 5.9% (95% CI: 1.4-16.9), respectively. Maternal complications included anemia (n = 11, 20.8%), arrhythmia (n = 2, 3.8%), heart failure (n = 2, 3.8%) and paravalvular leak (n = 2, 3.8%). There was one (1.9%) mitral valve thrombosis and one (1.9%) stuck valve in pregnancies who defaulted warfarin prior to pregnancy. There were no maternal deaths. Multidisciplinary management of pregnant women with prosthetic heart valves with anti-Xa adjusted low molecular weight heparin throughout pregnancy represents an effective anticoagulation option for low-middle-income countries.

A systematic approach for data generation for intelligent fault detection and diagnosis in District Heating

This study introduces a novel systematic approach to address the challenge of labeled data scarcity for fault detection and diagnosis (FDD) in District Heating (DH) systems. To replicate real-world DH fault scenarios, we have created a controlled laboratory emulation of a generic DH substation integrated with a climate chamber. Furthermore, we present an FDD pipeline using an isolation forest and a one-class support vector machine for fault detection alongside a random forest and a support vector machine for fault diagnosis. Our research analyzed the impact of data sampling frequencies on the FDD models, revealing that shorter intervals, such as 1-min and 5-min, significantly improve FDD performance. We provide detailed information on six scenarios, including normal operation, a minor valve leak, a valve leak, a stuck valve, a high heat curve, and a temperature sensor deviation. For each scenario, we present their signature, quantifying their unique behavior and providing deeper insights into the operational implications. The signatures suggest that, while variable, faults have a consistent pattern seen in the generic DH substation. While this work contributes directly to the DH field, our methodology also extends its applicability to a broader context where labeled data is scarce.

Improving the Efficiency of Fan Coil Units in Hotel Buildings through Deep-Learning-Based Fault Detection.

Optimizing the performance of heating, ventilation, and air-conditioning (HVAC) systems is critical in today's energy-conscious world. Fan coil units (FCUs) play a critical role in providing comfort in various environments as an important component of HVAC systems. However, FCUs often experience failures that affect their efficiency and increase their energy consumption. In this context, deep learning (DL)-based fault detection offers a promising solution. By detecting faults early and preventing system failures, the efficiency of FCUs can be improved. This paper explores DL models as fault detectors for FCUs to enable smarter and more energy-efficient hotel buildings. We tested three contemporary DL modeling approaches: convolutional neural network (CNN), long short-term memory network (LSTM), and a combination of CNN and gated recurrent unit (GRU). The random forest model (RF) was additionally developed as a baseline benchmark. The fault detectors were tested on a real-world dataset obtained from the sensory measurement system installed in a hotel and additionally supplemented with simulated data via a physical model developed in TRNSYS. Three representative FCU faults, namely, a stuck valve, a reduction in airflow, and an FCU outage, were simulated with a much larger dataset than is typically utilized in similar studies. The results showed that the hybrid model, integrating CNN and GRU, performed best for all three observed faults. DL-based fault detectors outperformed the baseline RF model, confirming these solutions as viable components for energy-efficient hotels.

Systematic analysis method of sensor and actuator faults propagation and impacts for optimally controlled complex building chilled water systems

The effectiveness of the commonly used optimal control strategy of a secondary chilled water system usually suffers from the health conditions of numerous sensors and actuators involved. This paper presents a systematic analysis method of sensor and actuator faults propagation and impacts for optimally controlled complex building chilled water systems. Through fault modelling and fault injection, the proposed method aims to analyze the sensor and actuator fault propagation behaviours between the control strategy and the chilled water system. Case studies have shown the results that the errors of sensors and actuators significantly affect the pump control performance and indoor thermal environment. The pump control performance is more sensitive to three sensors: the supply air temperature sensor, the indoor air temperature sensor and the valve opening signal sensor of the terminal at the critical hydraulic loop. The indoor thermal environment is more sensitive to the indoor air temperature sensor. Compared to the baseline case without errors, the maximum deviation could reach 29.20% and 11.11% (in Celsius) for the chilled water pump energy consumption and indoor temperature respectively, under 10% error of related sensors. Actuator fault, like stuck valve, would result in a deviation of up to 42.46% in the pump energy consumption and up to 16.87% (in Celsius) in the indoor temperature. For applications, the proposed method is hoping to acquire general symptoms under various types of sensor faults for the fault diagnosis and contribute to enhancing the robustness of the optimal chilled water pump control strategy.

Stuck valve and left atrial thrombus in a patient with hypereosinophilic syndrome.

Stuck valve and left atrial thrombus in a patient with hypereosinophilic syndrome.

Comprehensive evaluation of intermittent mechanical valve obstruction: a retrieval study of 16 cases

Abstract Funding Acknowledgements Type of funding sources: None. Background The intermittent stuck valve is a rarely defined clinical situation, which can be life-threatening or benign, and the clinical features are not well-known. Purpose A thorough investigation of the intermittent mechanical stuck valve"s etiology, diagnostic and treatment methods, and identifying parameters are associated with clinical severity Methods Over 11 years (2010- 2021), 16 patients were subsequently selected from referrals to the Kosuyolu Training and Research Hospital"s echocardiography department. We collected the data retrospectively. Results The evaluated patients consisted of 12 bi-leaflet mitral valve replacements (MVR) and two mono-leaflet MVR. Etiologies were classified as follows; residual chord with four patients, obstructive thrombus (OT) with two patients, non-obstructive thrombus (NOT) with two patients, vegetation with two patients, pannus, and OT coexistence with one patient, solely pannus with one patient. One of the residual chord patients with the frequency one of three-beat severe intermittent mitral regurgitation (MR) presented in dyspnea and underwent redo MVR. The other residual chord patients were in the mild condition who had lesser entrapment frequency. One of the two patients with OT had an ischemic cerebrovascular accident (CVA) with intermittent severe mitral stenosis (MS), while the other was in severe dyspnea. These two patients also underwent redo-MVR. Intermittent stuck valve due to NOT (n:2) presented with dyspnea. Both patients presented with intermittent moderate MR. Two patients presented with endocarditis with severe intermittent MR. One patient had obstruction one of the three beats due to the pannus formation who underwent surgery. One patient who recovered with TT had pannus and NOT coincidentally with a stuck valve in one of the three beats. One of the patients with mono-leaflet MVR had pannus and OT. In the other patient with mono-leaflet MVR, a stuck valve was observed in one of 12 beats secondary to arrhythmia. In the collected data, there were two aortic valve replacements (AVR). One patient had moderate aortic regurgitation due to prominent calcification; the other had moderate obstruction due to pannus. We decided on follow-up medical treatment for these patients with the aortic valve. In the patient with pannus, stuck valve formation occurred one of six beats, and moderate aortic regurgitation arose one of two beats in the patient with calcification. Conclusions The intermittent stuck valve is rarely defined, may have catastrophic outcomes and necessitates a comprehensive approach. It requires elaborative examination in symptomatic patients with prosthetic valves. When making a treatment decision in these patients, as in other native or prosthetic valve patients, the degree of regurgitation or stenosis is essential. In particular, for intermittent stuck valves, the frequency of entrapment should play a fundamental role in making treatment decisions Abstract table 1 Abstract table 2

Twisting of Tail End of the Reservoir Bag Malingering as Stuck Valve during Positive-pressure Ventilation

Twisting of Tail End of the Reservoir Bag Malingering as Stuck Valve during Positive-pressure Ventilation

Mechanical prosthetic valve thrombosis in current era: 5-year follow-up.

The incidence of prosthetic valve dysfunction (stuck valve) is variable and is dependent on various factors. There are studies from Indian groups that have emphasized the success of thrombolysis; however, none of them reported a follow-up. This study was designed to emphasize on the follow-up of these patients at midterm. The patients of prosthetic valve thrombosis between period of January 2013 and December 2017 were included in this retrospective observational study. Sixty-six patients were admitted with stuck valve during this period. Thrombolysis was preferred modality of treatment. Survivors were followed up with serial echocardiography, which included estimation of left ventricular and valve functions. Of a total of 66 patients, 59 were of stuck mitral valve and 7 stuck aortic valve. The event happened at a mean of 48.86 ± 48.80months after index operation of valve replacement using mechanical valve prosthesis. The median age was 40.27 ± 10.8years with 39 males and 27 females. Thrombolysis was successful in 61 patients with a mortality of 5 (7.57%). During a mean follow-up of 22.7 ± 20.9months, 42 patients were alive with 14 (22.95%) patients dead and 5 patients lost to follow-up. The average follow-up was 18.7 ± 22.7months before death. Following good early results after thrombolysis, patients of prosthetic heart valve thrombosis experience high mortality within 2years of follow-up. These patients require frequent follow-up to avoid early mortality.

Midterm outcomes after the rescue THV-in-THV procedure: Insights from the multicenter prospective OCEAN-TAVI registry.

To confirm whether the rescue transcatheter heart valve in the transcatheter heart valve (THV-in-THV) procedure is effective and feasible, we aimed to assess the midterm outcomes following rescue THV-in-THV procedures. The trends in the usage of the rescue THV-in-THV procedure at the time of transcatheter aortic valve implantation (TAVI) have also been explored. Midterm outcomes of the rescue THV-in-THV procedure have been poorly defined, though it is popular as an effective method to bail-out some complications in TAVI. We reviewed data from the Optimized transCathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry and compared the outcomes of TAVI with rescue THV-in-THV and TAVI without rescue THV-in-THV. We also examined the annual rates of rescue THV-in-THV procedures in all the TAVI procedures between 2013 and 2017. Among 2,588 patients who underwent TAVI, 26 patients have required rescue THV-in-THV for valve malposition (n = 23) or severe transvalvular regurgitation because of stuck THV leaflets (n = 3). Three cases needed an open conversion, and two died in the hospital. The rates of new permanent pacemaker implantation, acute kidney injury, and stroke were higher in the THV-in-THV group. A two-year cumulative survival and echocardiographic outcomes succeeding rescue THV-in-THV procedure were comparable to non-THV-in-THV cases. The rate of rescue THV-in-THV procedure lessened from 2.6% in 2013 to 0.6% in 2017. The rescue THV-in-THV procedure is an effective and feasible option for THV malpositioning and stuck valve. It has given a comparable survival and a stable valve function over midterm observation periods.

P6487Sequential combination of different thrombolytic therapy regimens in the management of patients with prosthetic valve thrombosis and stuck valves

Abstract Introduction Prosthetic valve thrombosis (PVT) is serious complication among patients with prosthetic heart valves. Recently, thrombolytic therapy (TT) regimens with low-dose, slow and ultra-slow infusions of tissue type plasminogen activator (tPA) has been widely used as a first-line treatment for PVT. PVT with stuck valves is a special entity which deserves particular management. In our study, we aimed to investigate the effectiveness and safety of sequential combination of different TT regimens in the management of patients with PVT and stuck valves. Methods The study included 52 patients with PVT and stuck valves [female: 34 (65.4%), mean age: 47.5±12.4] who underwent TT with sequential combination of slow (25mg/6 hours) and ultra-slow (25mg/25 hours) infusion of low dose t-PA regimens which was mainly based on the New York Heart Association functional class of the patients according to a previously established algoritm. All patients were evaluated by cinefluoroscopy, transthoracic and transesophageal echocardiography (Figure 1). Results The median number of TT sessions with slow and ultra-slow infusion of tPA were 1 (0–2.75) and 3 (1.25–5) respectively. Total tPA dose was 120 (96–175) mg and TT was successful in 46 (88.4%) patients. There were 3 major complications (cerebrovascular accident: 1, intracranial bleeding: 1, gastrointestinal bleeding requiring transfusion: 1) and 6 minor complications. The in-hospital mortality rate was 1.9%. Increased thrombus area was found to be the only independent predictor of both failed TT and adverse events. Thrombus area above 1.45 cm2 predicted failed TT with a sensitivity of 83% and a specificity of 70% (AUC: 0.871; 95% CI: 0.752–0.991; p=0.003) and predicted adverse events with a sensitivity of 77% and a specificity of 73% (AUC: 0.854; 95% CI: 0.747–0.961; p=0.001). There was a moderate positive correletion between thrombus area and total tPA dose used (r=479; p<0.001). Figure 1 Conclusion This study demostrated that TT with sequential combination of slow and ultra-slow infusion of low dose t-PA regimens may be useful for the treatment of patients with PVT and stuck valves with acceptable success and complications rates.

A case of a woman with prosthetic mechanical heart valve replacement who suffered from a stuck valve during administration of heparin calcium self-injection at home

A case of a woman with prosthetic mechanical heart valve replacement who suffered from a stuck valve during administration of heparin calcium self-injection at home

Prosthetic valve thrombosis in a tertiary cardiac centre

Background and Aims: Prosthetic valve thrombosis remains a major complication of valve replacement surgeries in Nepal. A number of patients present with thrombotic complications mainly due to poor anticoagulation status with irregular INR checkup at the remote areas of Nepal. Thrombolysis is the preferred method in the management of stuck valve patients due to financial issues . We aimed to retrospectively study the clinical profile and management trends of stuck prosthetic valveMethods: A one year retrospective data of 23 patients (Jan 2015 - Jan 2016) admitted with diagnosis of prosthetic valve thrombosis were studied. The demographic profile, clinical parameters and in hospital outcome were analysed.Results: Out of 23 patients, majority were female (52.2%) with the age group 13-49 years (mean = 35). Sixteen patients (69.6%) presented with INR value < 1.5 at admission. Twenty patients ( 86.9%) were thrombolysed with streptokinase while 3 patients ( 13.1 %) were subjected to treatment with tenecteplase . Valve thrombosis was most common at the mitral position 17 (73.9%) patients. In hospital mortality was seen in 5 ( 21.7%) patients and there were no major bleeding events or new stroke noted.Conclusion: Majority of patients with prosthetic valve thrombosis presented with a subtherapeutic INR value. Thrombolysis can be a useful option in the management of prosthetic valve thrombosis patients in a less resourceful country.Nepalese Heart Journal 2017; 14(1): 9-11

English

English

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

An eventful second natural history of a congenital bicuspid aortic valve followed up for 40 years

The second natural history of a congenital bicuspid aortic valve with the early symptomatic presentation is eventful. The spectrum takes it start from intrauterine life. The cumulative history may include valvotomy by balloon or surgery, valve replace replacement, stuck valve, thromboembolic complications, thrombolysis, anticoagulation-related bleeding diathesis, redo of replacement, and transcathetor aortic valve implantation. In addition, a retained foreign body granuloma in such cases further lengthens the story. We report a 48-year-old male with congenitally single kidney who underwent redo aortic valve replacement (AVR) and resection textiloma after 15 years of AVR. The eventful second natural history included surgical valvotomy in pre-balloon valvotomy era, AVR, thrombolysis for stuck valve for six times, thromboembolic episode, redo AVR, and excision of paracardiac textiloma.

Surgical Outcome in Hemodialysis Patients with Active-Phase Infective Endocarditis.

The aim of this study was to elucidate the characteristics of chronic hemodialysis (HD) patients requiring surgery during the active phase of infective endocarditis (IE). From December 2004 to July 2015, 58 patients underwent surgery in our institute for active IE. Seven patients had been on HD for 1-15 years. Their preoperative profiles and surgical outcomes were compared to those of the other 51 patients (non-HD group). The predominant causative microorganisms in the HD group were Staphylococcus spp, particularly methicillin-resistant Staphylococcus aureus (MRSA), whereas Streptococcus spp were predominant in the non-HD group. Prosthetic dysfunction (stuck valve after mechanical and structural valve dysfunction following bioprosthetic valve replacement), complete atrioventricular (AV) block, and annular abscess formation were more frequent in the HD group. In-hospital mortality was higher in the HD group (29% vs. 6%, p = 0.044). Actuarial survival in the HD and non-HD groups was 43% vs. 87% at 5 years and 43% vs. 76% at 10 years (p = 0.007). Early and long term outcomes in patients with chronic HD were poor. Compared to other patients, chronic HD patients undergoing valve surgery during active IE had higher incidences of MRSA infection, annular abscess formation, postoperative valve dysfunction, and postoperative complete AV block.

Anesthetic management of a pregnant patient who underwent surgery due to stuck valve

Anesthetic management of a pregnant patient who underwent surgery due to stuck valve

A study of indications, complications of prosthetic valves and prognosis after treatment of stuck valve

A study of indications, complications of prosthetic valves and prognosis after treatment of stuck valve

54. Fibrinolytic therapy and polyvalvular heart disease in pediatric patient

Introduction Novel therapy for a stuck mechanical heart valve in pediatric patient with multiple prosthetic valves. Not much is known with the use of anticoagulation and fibrinolysis in multiple mechanical valves in pediatric patients. Case presentation 10 year, Saudi, male with poly-valvular disease with tricuspid, mitral, and aortic, and pulmonary valve regurgitation. Initially, he had repair of all his valves in June 2008. He required Mitral valve replacement #21, and repeat poly-valvar repair in July 2008. Eventually, tricuspid valve was replaced by CM #27, aortic valve was replaced by St.Jude #19 mm, and pulmonary valve replaced by Jan 2012. He presented to cardiology clinic on March 2014 in which found to have stuck disc of the tricuspid valve prosthesis on echo with increasing gradients of six mmHg, despite therapeutic INR with warfarin. Immediate fluoroscopy confirmed diagnosis. Physical exam positively mild tachypnea and liver of three cm below costal margin, with mechanical cardiac click sounds. Immediate admission to the intensive care for observation and planning starting the tPA with heparin infusion. TPA stated as a dose of 0.5 mg/kg/h over 6 h then repeated fluoroscopy done after 4 h of the completion of tPA showed mobile tricuspid disc. He was observed for a few days in ward with therapeutic INR and discharged home. Conclusion As growing surgical skills we are facing many pediatric cases with prosthetic valves with stuck valves. Which tPA dose should be used? Is streptokinase better? How long do you wait before considering surgery?

TCTAP A-180 Safety and Efficacy of Thrombolysis for Stuck Valve in Rheumatic Heart Disease - A Single Centre Experience

TCTAP A-180 Safety and Efficacy of Thrombolysis for Stuck Valve in Rheumatic Heart Disease - A Single Centre Experience