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Management of prosthetic valve thrombosis

D. Hering1, C. Piper and D. Horstkotte

Department of Cardiology, Heart Center North Rhine-Westphalia, Ruhr University, Bad Oeynhausen, Germany

1 Correspondence: Detlef Hering, MD, Department of Cardiology, Heart Center North Rhine-Westphalia, Ruhr University, Bad Oeynhausen, Georgstraße 11, D-32545 Bad Oeynhausen, Germany.

Abstract

Fibrinolysis and surgery with either valvular re-replacement or thrombectomy are both established therapies for prosthetic valve thrombosis. In both treatment strategies, the complication rate depends to a similar degree on pre-interventional clinical and haemodynamic status. Fibrinolysis serves to avoid a second operation, but the incidence of recurrent thrombosis is higher. Before deciding in favour of thrombolytic therapy, structural defects of the prosthetic valve or tissue in-growth, which increase the risk of rethrombosis, should be ruled out by transoesophageal echocardiography. Apart from those cases in which there are contraindications to either treatment, we recommend surgery in cases of underlying prosthetic valve dysfunction or recurrent thrombosis.

Key Words: Prosthetic valve thrombosis • thrombectomy • thrombolytic therapy • valve replacement

References

  1. Witchitz S, Veyrat C, Moisson P, Scheinman N, Rozenstajn L. Fibrinolytic treatment of thrombus on prosthetic heart valves. Br Heart J. 1980;44:545–554[Abstract/Free Full Text]
  2. Ledain LD, Ohayon JP, Colle JP, Lorient-Roudaut FM, Roudaut RP, Besse PM. Acute thrombotic obstruction with disc valve prostheses: diagnostic considerations and fibrinolytic treatment. J Am Coll Cardiol. 1986;7:743–751[Abstract]
  3. Roudaut R, Labbe T, Lorient-Roudaut MF, et al. Mechanical cardiac valve thrombosis. Is fibrinolytis justified? Circulation. 1992;86(suppl 11):8–15
  4. Vasan RS, Kaul U, Sanghvi S, et al. Thrombolytic therapy for prosthetic valve thrombosis: a study based on serial Doppler echocardiographic evaluation. Am Heart J. 1992;123:1575–1580[CrossRef][Web of Science][Medline]
  5. Silber H, Khan SS, Matloff JM, Chaux A, deRobertis M, Gray R. The St. Jude valve. Thrombolysis as the first line of therapy for cardiac valve thrombosis. Circulation. 1993;87:30–37[Abstract/Free Full Text]
  6. Reddy NK, Padmanabhan TNC, Singh S, et al. Thrombolysis in left-sided prosthetic valve occlusion: immediate and follow-up results. Ann Thorac Surg. 1994;58:462–471[Abstract]
  7. Manteiga R, Souto JC, Altes A, et al. Short-course thrombolysis as the first line of therapy for cardiac valve thrombosis. J Thorac Cardiovasc Surg. 1998;115:780–784[Abstract/Free Full Text]
  8. Vitale N, Renzulli A, Cerasuolo F, et al. Prosthetic valve obstruction: thrombolysis versus operation. Ann Thorac Surg. 1994;57:365–370[Abstract]
  9. Renzulli A, Vitale N, Caruso A, Dialetto G, de Luca Tupputi Schinosa L, Cotrufo M. Thrombolysis for prosthetic valve thrombosis: indications and results. J Heart Valve Dis. 1997;6:212–218[Web of Science][Medline]
  10. Özcan M, Kaymaz C, Kirma C, et al. Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: a study using serial transesophageal echocardiography. J Am Coll Cardiol. 2000;35:1881–1889[Abstract/Free Full Text]
  11. Gupta D, Kothari SS, Bahl VK, et al. Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results. Am Heart J. 2000;140:906–916[CrossRef][Web of Science][Medline]
  12. Shapira Y, Sagie A, Jortner R, Adler Y, Hirsch R. Thrombosis of bileaflet tricuspid valve prosthesis: clinical spectrum and the role of nonsurgical treatment. Am Heart J. 1999;137:721–725[CrossRef][Web of Science][Medline]
  13. Ayuso LA, Juffe A, Rufilanchas JJ, Babin F, Burgos R, Figuera D. Thrombectomy: surgical treatment of the thrombosed Björk-Shiley prosthesis. J Thorac Cardiovasc Surg. 1982;84:906–910[Abstract]
  14. Venugopal P, Kaul U, Iyer KS, et al. Fate of thrombectomized Björk-Shiley valves. A long-term cinefluoroscopic, echocardiographic, and hemodynamic evaluation. J Thorac Cardiovasc Surg. 1986;91:168–173[Abstract]
  15. Massad M, Fahl M, Slim M, et al. Thrombosed Björk-Shiley standard disc mural valve prosthesis. J Cardiovasc Surg. 1989;30:976–980[Medline]
  16. Kontos GJ, Schaff HV, Orszulak TA, Puga FJ, Pluth JR, Danielson GK. Thrombotic obstruction of disc valves: clinical recognition and surgical management. Ann Thorac Surg. 1989;48:60–65[Abstract]
  17. Montero CG, Mula N, Brugos R, Pradas R, Figuera D. Thrombectomy of the Björk-Shiley prosthetic valve revisited: long-term results. Ann Thorac Surg. 1989;48:824–8248[Abstract]
  18. Martinell J, Jiménez A, Rábago G, Artiz V, Fraile J, Farré J. Mechanical cardiac valve thrombosis. Is thrombectomy justified? Circulation. 1991;84(suppl III):70–75
  19. Deviri E, Sareli P, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management. J Am Coll Cardiol. 1991;17:646–650[Abstract]
  20. Tsai KT, Lin PJ, Chang CH, et al. Surgical management of thrombotic disc valve. Ann Thorac Surg. 1993;55:98–101[Abstract]
  21. Sivasubramanian S, Vijayshankar CS, Krishnamurthy SM, Santhosham R, Dwaraknath V, Rajaram S. Surgical management of prosthetic valve obstruction with the Sorin tilting disc prosthesis. J Heart Valve Dis. 1996;5:548–552[Web of Science][Medline]
  22. Kayali MT, Fetieh MW, Abdulsalam MA, Memon F, Moinuddin M, Raffa H. Thrombotic obstruction of bileaflet mechanical prosthetic heart valves: early diagnosis and management. J Cardiovasc Surg. 1998;39:331–335[Medline]
  23. Carrier M, Pellerin M, Dagenais F, Perrault LP, Petitclerc R, Pelletier LC. Video-assisted thrombectomy of mechanical prosthetic heart valves. J Heart Valve Dis. 1999;8:404–406[Web of Science][Medline]
  24. Horstkotte D, Burckhardt D. Prosthetic valve thrombosis. J Heart Valve Dis. 1995;4:141–153[Medline]
  25. Péterffy A, Henze A, Savidge GF, Landou C, Björk VO. Late thrombotic malfunction of the Björk-Shiley tilting disc valve in the tricuspid position. Principles for recognition and management. Scand J Thorac Cardiovasc Surg. 1980;14:33–41[Web of Science][Medline]
  26. Thorburn CW, Morgan JJ, Shanahan MX, Chang VP. Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis. Am J Cardiol. 1983;51:1128–1132[CrossRef][Web of Science][Medline]
  27. Pavie A, Bors V, Baud F, Gandjbakhch I, Cabrol C. Surgery of prosthetic valve thrombosis. Eur Heart J. 1984;5(suppl D):39–42
  28. Rizzoli G, Guglielmi C, Toscano G, et al. Reoperations for acute prosthetic thrombosis and pannus: an assessment of rates, relationship and risk. Eur J Cardiothorac Surg. 1999;16:74–80[Abstract/Free Full Text]
  29. Bortolotti U, Milano A, Mossuto E, Mazzaro E, Thiene G, Casarotto D. Early and late outcome after reoperation for prosthetic valve dysfunction: analysis of 549 patients during a 26-year period. J Heart Valve Dis. 1994;3:81–87[Medline]
  30. Piehler JM, Blackstone EH, Bailey KR, et al. Reoperations on prosthetic heart valves. Patient-specific estimates of in-hospital events. J Thorac Cardiovasc Surg. 1995;109:30–48[Abstract/Free Full Text]
  31. Björk VO, Henze A. Encapsulation of the Björk-Shiley aortic disc valve caused by the lack of anticoagulation treatment. Scand J Thorac Cardiovasc Surg. 1973;7:17–20[Medline]
  32. Luluaga IT, Carrera D, D'Oliveira J, et al. Successful thrombolytic therapy after acute tricuspid valve obstruction. Lancet. 1971;i:1067–1068
  33. Lengyel M, Fuster V, Keltai M, et al. Guidelines for management of left-sided prosthetic valve thrombosis: a role for thrombolytic therapy. J Am Coll Cardiol. 1997;30:1521–1526[Abstract]
  34. Bonow RO, Carabello B, de Leon AC, et al. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of patients with valvular heart disease). J Am Coll Cardiol. 1998;32:1486–1588[Free Full Text]
  35. Lengyel M, Vegh G, Vandor L. Thrombolysis is superior to heparin for non-obstructive mural mechanical valve thrombosis. J Heart Valve Dis. 1999;8:167–173[Web of Science][Medline]
  36. Birdi I, Angelini GD, Bryan AJ. Thrombolytic therapy for left sided prosthetic heart valve thrombosis. J Heart Valve Dis. 1995;4:154–159[Medline]
  37. Dzavik V, Cohen G, Chan KL. Role of transesophageal echocardiography in the diagnosis and management of prosthetic valve thrombosis. J Am Coll Cardiol. 1991;18:1829–1833[Abstract]
  38. Barbetseas J, Nagueh SH, Pitsavos C, et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and trans esophageal echocardiographic parameters. J Am Coll Cardiol. 1998;32:1410–1417[Abstract/Free Full Text]
  39. Pereira AC, Martin PJ, Warburton EA. Thrombolysis in acute ischaemic stroke. Postgrad Med J. 2001;77:166–171[Free Full Text]
  40. Devuyst G, Bogousslavsky J. Recent progress in drug treatment for acute ischemic stroke. Cerebrovasc Dis. 2001;11(suppl 1):71–79
  41. Piper C, Wiemer M, Schulte HD, Horstkotte D. Stroke is not a contraindication for urgent valve replacement in acute infective endocarditis. J Heart Valve Dis. 2001;: in press
  42. Horstkotte D, Scharf RE, Schultheiss HP. Intracardiac thrombosis: patient-related and device-related factors. J Heart Valve Dis. 1995;4:114–120[Medline]

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