-
South African Medical Journal =... Nov 1985Despite recent advances in the perfection of cardiac valve prostheses, complications still bedevil the currently available models. To a degree, valve replacement is... (Review)
Review
Despite recent advances in the perfection of cardiac valve prostheses, complications still bedevil the currently available models. To a degree, valve replacement is simply exchanging one disease for another. Mechanical prostheses are durable but associated with a high incidence of thrombo-embolic complications, while tissue valves are more resistant to thrombosis and thrombo-embolism but lack durability. The choice of prosthesis must be tailored to the individual patient's requirements, keeping in mind the social, economic and cultural characteristics of the population. Qualified support for conservative valve surgery (valvuloplasty) whenever reasonably possible would seem appropriate, even if it is later proved to have limited durability.
Topics: Adult; Age Factors; Anticoagulants; Bioprosthesis; Child; Endocarditis; Female; Heart Valve Prosthesis; Humans; Middle Aged; Pregnancy; Pregnancy Complications; Prosthesis Failure; Reoperation; Socioeconomic Factors; Thromboembolism; Time Factors
PubMed: 3904038
DOI: No ID Found -
BMJ Case Reports Oct 2017Prosthetic heart valve thrombosis (PHVT) is a major cause of morbidity and mortality in patients with mechanical heart valves. We present a case of recurrent PHVT...
Prosthetic heart valve thrombosis (PHVT) is a major cause of morbidity and mortality in patients with mechanical heart valves. We present a case of recurrent PHVT associated with eosinophilia. A 17-year-old girl underwent aortic and mitral valve replacement for rheumatic heart disease. Over a period of 4 years, she had four episodes of PHVT despite oral anticoagulation with adequate INR. Her investigations revealed eosinophilia which was missed during the previous episodes. No further episodes of PHVT occurred after treatment of eosinophilia with steroids on limited follow-up.
Topics: Adolescent; Aortic Valve; Coronary Thrombosis; Diagnostic Errors; Eosinophilia; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Recurrence; Rheumatic Heart Disease
PubMed: 28974508
DOI: 10.1136/bcr-2017-221313 -
Progress in Cardiovascular Diseases 1983There are a number of difficulties inherent in the analysis of such a large and diverse quantity of data. In a substantial number of clinical trials, there is no... (Review)
Review
There are a number of difficulties inherent in the analysis of such a large and diverse quantity of data. In a substantial number of clinical trials, there is no significant effort made to evaluate prosthetic performance as a function of preoperative cardiac anatomy. Hemodynamics have not been systematically studied in relation to preexisting left ventricular size, shape, or configuration, mitral annular orientation, or left atrial size. Postoperative anticoagulation protocols vary from one institution to another and occasionally within study groups themselves. Less tangible variables such as alteration in surgical technique over time and differential familiarity of cardiovascular surgeons with the prostheses employed are chronic problems in any study of this sort. Perhaps the greatest variable in evaluating the postoperative performance of valvular prostheses over the past 20 yr is the radical improvement in techniques of intraoperative myocardial preservation. Notwithstanding, comparisons are possible within the confines of certain criteria. The caged ball value remains in use after 20 years of clinical experience. It has sustained the greatest number of modifications, probably because it has been the most extensively studied. Hemodynamics are adequate although its centrally obstructed design is responsible for increased turbulence, hemolysis, and neointimal proliferation, particularly in the aortic position. The device has been shown to be durable with virtually no reports of ball variance since the alteration of the silicone curing procedure in 1965. Thromboembolic rates are acceptable in the anticoagulated patient while prosthetic thrombosis is not a grave threat in the non-close clearance device. Incidence of endocarditis is not particularly different from that associated with all nonbioprosthetic valves, although there is a much greater published volume of clinical experience concerning recognition and treatment of late prosthetic valve endocarditis in patients with caged ball valves than there is for any other replacement device. Perhaps the most serious disadvantage to caged ball design is its size. Its large spatial requirements have led to anatomic complications in patients with small aortic roots, isolated mitral stenosis, left ventricular hypertrophy, and double valve replacement, among others. Nevertheless, this is still the valve of choice in some centers.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: Anemia, Hemolytic; Aortic Valve; Bioprosthesis; Coronary Circulation; Endocarditis; Heart Valve Prosthesis; Humans; Mitral Valve; Postoperative Complications; Prosthesis Design; Thrombosis
PubMed: 6359270
DOI: 10.1016/0033-0620(83)90008-7 -
International Journal of Cardiology Sep 2018
Topics: Aortic Valve; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Valves; Prosthesis Failure; Tomography; Tomography, X-Ray Computed
PubMed: 29887447
DOI: 10.1016/j.ijcard.2018.02.004 -
European Journal of Cardio-thoracic... 1989Acute thrombotic obstruction of prosthetic heart valves has usually needed an emergency operation and carries a high mortality. Over the past 16 years, sporadic papers... (Review)
Review
Acute thrombotic obstruction of prosthetic heart valves has usually needed an emergency operation and carries a high mortality. Over the past 16 years, sporadic papers have appeared reporting the successful use of fibrinolytic therapy with a low mortality. We report five consecutive cases treated in this way. The diagnosis of valve thrombosis was made on clinical, echocardiographic and cineradiographic grounds. Treatment consisted of streptokinase (SPK) in a loading dose of 250,000 units in one case and 500,000 units in the remaining four cases, followed by 100,000 units hourly. Rapid improvement in clinical state was seen in all five patients. Four patients recovered completely and have been followed up for a minimum of 3 years. One patient died of a retroperitoneal haemorrhage, a recognised complication of fibrinolytic therapy. A review of the literature is presented. Fibrinolytic therapy is recommended in the acute episode and should result in either a return to normal valve function or sufficient improvement in haemodynamics to allow semielective surgery at considerably lower risk.
Topics: Adult; Aortic Valve; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Streptokinase; Thrombolytic Therapy; Thrombosis; Tricuspid Valve
PubMed: 2697315
DOI: 10.1016/1010-7940(89)90099-7 -
Cleveland Clinic Journal of Medicine Jun 2002
Topics: Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Prognosis; Prosthesis Design; Prosthesis Failure
PubMed: 12061457
DOI: 10.3949/ccjm.69.6.448 -
The New England Journal of Medicine Jan 1997
Topics: Heart Valve Prosthesis; Humans; Prosthesis Design; Prosthesis Failure
PubMed: 8992356
DOI: No ID Found -
The New England Journal of Medicine Jan 1997
Topics: Bioprosthesis; Heart Valve Prosthesis; Humans; Prosthesis Design; Stents
PubMed: 8992353
DOI: 10.1056/NEJM199701163360313 -
European Heart Journal Apr 1993Early diagnosis of acute prosthetic thrombosis remains a challenge. In 20 patients with 23 thrombosed cardiac valves, we evaluated the respective value of transthoracic...
Early diagnosis of acute prosthetic thrombosis remains a challenge. In 20 patients with 23 thrombosed cardiac valves, we evaluated the respective value of transthoracic (TTE) and transoesophageal (TEE) Doppler echocardiography. According to the presence or absence of prosthetic obstruction by continuous-wave Doppler, prostheses were separated into two groups. Group 1 included nine thrombosed prostheses (8 mitral, 1 aortic) with severe obstruction. All patients presented with severe symptoms of heart failure. Transthoracic Doppler echocardiography allowed immediate diagnosis of prosthetic thrombosis, even in critically ill patients, showing (1) eccentric transprosthetic colour flow jets in all eight mitral prostheses, (2) severe obstruction on Doppler examination (mean gradient = 18 to 36 mmHg in eight mitral prostheses, and 69 mmHg in one aortic valve), and (3) direct echocardiographic evidence of thrombosis (i.e. thrombus or abnormal disc or leaflet motion) in four patients. All nine patients were immediately treated by surgery (n = 8) or fibrinolysis (n = 1) on the basis of TTE results only. TEE allowed better visualization of thrombus and restricted leaflet or disc motion, but had little influence on patient management. Group 2 included 14 thrombosed prostheses (10 mitral, 4 aortic) with mild or absent obstruction. In three patients with massive mitral prosthetic thrombosis, an associated minimal thrombosis of a prosthetic aortic valve was found at surgery, but was detected neither by TTE, nor by TEE. The 11 remaining patients with isolated partial mitral (n = 10) or aortic (n = 1) thrombosis. Clinical presentation was fever, cerebral embolism, or mild dyspnoea, but no heart failure. TTE was normal in all.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Aortic Valve; Echocardiography, Doppler; Female; Heart Failure; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Pulmonary Edema; Thrombosis
PubMed: 8472706
DOI: 10.1093/eurheartj/14.4.447 -
The Journal of Thoracic and... Jan 1987We report the results and long-term follow up in 273 children (aged 2 to 16 years) who underwent prosthetic valve replacement. Mechanical valves (mostly Starr-Edwards)...
We report the results and long-term follow up in 273 children (aged 2 to 16 years) who underwent prosthetic valve replacement. Mechanical valves (mostly Starr-Edwards) were used in almost all, and in 62 children more than one valve was replaced. Operative mortality was 4.7%. Actuarial survival curves (including hospital mortality) indicate a 86% survival rate at 5 years and 75% at 10 years. For isolated mitral valve prostheses (the largest subgroup), the figures are 87% at 5 years and 82% at 10 and 15 years. The main complication was thromboembolism, which occurred at a linearized rate of 2.7 per 100 patient-years. Actuarial curves indicate that 88% of patients are embolus free at 5 years, and 77% at 10 years. No patient with aortic valve replacement only had an embolism. Five of eight tricuspid prostheses thrombosed. Patients given aspirin and dipyridamole only did not have a higher rate of thromboembolic events than those given warfarin. There were five cases of endocarditis (two fatal) and four of dehiscence. No patient so far has needed replacement of a prosthesis because of somatic growth. Thus valve replacement can be performed with low mortality in children, and with satisfactory long-term survival. Thromboembolism remains a significant problem, although it appears to be less common than in adults. In this study, treatment with antiplatelet drugs only did not carry a higher rate of thromboembolic events than did treatment with warfarin.
Topics: Actuarial Analysis; Adolescent; Anticoagulants; Aortic Valve; Child; Child, Preschool; Endocarditis, Bacterial; Female; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Prosthesis Design; Thromboembolism
PubMed: 3796033
DOI: No ID Found