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Journal of the American College of... Dec 2016Although surgery was the mainstay of treatment for valvular heart disease, transcatheter valve therapies have grown exponentially over the past decade. Two types of... (Review)
Review
Although surgery was the mainstay of treatment for valvular heart disease, transcatheter valve therapies have grown exponentially over the past decade. Two types of artificial heart valve exist: mechanical heart valves (MHV), which are implanted surgically, and bioprosthetic heart valves (BHV), which can be implanted via a surgical or transcatheter approach. Whereas long-term anticoagulation is required to prevent thromboembolism after MHV replacement, its value in patients receiving BHVs is uncertain. Patients undergoing transcatheter BHV replacement are at risk for thromboembolism in the first few months, and recent data suggest that the risk continues thereafter. BHV thrombosis provides a substrate for subsequent thromboembolism and may identify a reversible cause of prosthesis dysfunction. Hereafter, the authors: 1) review the data on prosthetic valve thrombosis; 2) discuss the pathophysiological mechanisms that may lead to valve thrombus formation; and 3) provide perspective on the implications of these findings in the era of transcatheter valve replacement.
Topics: Anticoagulants; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Prosthesis Failure; Thrombosis
PubMed: 27978952
DOI: 10.1016/j.jacc.2016.09.958 -
Journal of the American College of... May 2023Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can... (Review)
Review
Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomography, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Transcatheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation.
Topics: Humans; Thrombosis; Bioprosthesis; Heart Valve Prosthesis; Anticoagulants; Heart Valves
PubMed: 37225366
DOI: 10.1016/j.jacc.2023.03.412 -
Methodist DeBakey Cardiovascular Journal 2022Despite improvements and advancements in surgical technique, paravalvular leaks (PVL) continue to present a challenge when caring for patients with prosthetic valve...
Despite improvements and advancements in surgical technique, paravalvular leaks (PVL) continue to present a challenge when caring for patients with prosthetic valve disease. Paravalvular leaks result from dehiscence of the surgical ring from the mitral annulus. Some theories suggest that uneven distribution of collagen fibers in the mitral annulus leaves the posterior mitral annulus without a well-formed fibrous structure, which may predispose it to recurrent mechanical injury that leads to PVL. The reported incidence of PVL is 2.2%. Risk factors associated with PVL include the presence of mitral annular calcification, infective endocarditis, active steroid use, and continuous surgical suturing, which poses a greater risk than an interrupted surgical approach. Risk of PVL varies by prosthesis type, with mechanical prostheses carrying a higher risk of PVL than bioprosthetic valves. Below are images of a 70-year-old male with severe mitral stenosis and pulmonary hypertension who had previously undergone mitral valve commissurotomy and subsequent mitral valve replacement with a bioprosthetic mitral valve. He presented to the hospital with pulmonary edema. Initial transthoracic echocardiogram showed depressed biventricular function with a dehiscence of the bioprosthetic mitral valve and a large eccentric posterior PVL, severe tricuspid regurgitation, and severe pulmonary hypertension. Transesophageal images in illustrate a significant posterior PVL with dehiscence of the prosthetic valve from the mitral annulus. The patient underwent closure of the paravalvular leak with two 18-mm Amplatzer ventricular septal defect occluders (Abbott) with excellent results and trace residual mitral regurgitation post closure ( ).
Topics: Aged; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Hypertension, Pulmonary; Male; Mitral Valve; Mitral Valve Insufficiency; Prosthesis Failure; Treatment Outcome
PubMed: 35432730
DOI: 10.14797/mdcvj.1096 -
BMJ Case Reports Aug 2019A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction....
A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction. He was an hepatic transplant recipient and was medicated with everolimus. He underwent mitral and aortic valve replacement with prosthetic valves 4 years ago. Due to his medical background, therapy and clinical presentation, empirical therapy for infective endocarditis was started. Transoesophageal echocardiogram showed severe aortic valve regurgitation but no other findings suggestive of endocarditis. Computed tomography (CT) revealed pulmonary infiltrates compatible with infection and no evidence of septic embolisation. Multiple sets of blood cultures were negative. was isolated in bronchial lavage and antibiotic therapy was adjusted. The patient underwent aortic valve replacement, with no macroscopic findings suggestive of endocarditis. was isolated in the surgically removed valve. Dual antibiotic therapy was successfully administered for 6 weeks.
Topics: Acute Disease; Anti-Bacterial Agents; Aortic Valve Insufficiency; Bronchoalveolar Lavage Fluid; Bronchoscopy; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Lung; Male; Middle Aged; Proteus mirabilis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31466989
DOI: 10.1136/bcr-2019-230575 -
Anatolian Journal of Cardiology Dec 2016Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of... (Review)
Review
Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of prosthetic valve thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical prosthetic valve thrombosis.
Topics: Heart Valve Diseases; Heart Valve Prosthesis; Heart Valves; Humans; Mitral Valve; Thrombolytic Therapy; Thrombosis
PubMed: 28005024
DOI: 10.14744/AnatolJCardiol.2016.7486 -
Gaceta Medica de Mexico 2022Heart valve bioprostheses are the gold standard for aortic valve surgical replacement in selected patients.
INTRODUCTION
Heart valve bioprostheses are the gold standard for aortic valve surgical replacement in selected patients.
OBJECTIVE
To evaluate the safety and efficacy of the National Institute of Cardiology (INC) bioprosthetic heart valve in humans.
METHODS
Single-center study that included 341 patients who underwent single surgical aortic valve replacement with INC heart valve.
RESULTS
318 implants were performed de novo (93%) and 23 as redo surgery (7%); STS scores were 1.4 and 1.8%, and follow-up was for 42 and 46 months, respectively. There were no differences in clinical complications or pacemaker implantation rate. Both groups maintained a normal LVEF. Overall improvement in functional class was observed, with worsening only in two patients of the de novo group. INC prosthesis dysfunction requiring surgical reintervention was observed in eight patients (4.65%) of the de novo group vs. one patient in the redo group.
CONCLUSIONS
The INC heart valve is efficacious and safe, and is associated with a low rate of complications and functional class improvement during long-term follow-up. Prospective, comparative studies of this valve are required.
Topics: Humans; Heart Valve Prosthesis Implantation; Prospective Studies; Aortic Valve; Heart Valve Prosthesis; Prosthesis Failure; Cardiology; Treatment Outcome; Aortic Valve Stenosis; Reoperation
PubMed: 36657112
DOI: 10.24875/GMM.M22000715 -
Neurology India 2023
Topics: Humans; Heart Valve Prosthesis; Anticoagulants; Heart Valves
PubMed: 38174484
DOI: 10.4103/0028-3886.391345 -
Journal of the American College of... Nov 2015Bioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these... (Review)
Review
Bioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these prostheses in the future. The current standard of care for treating bioprosthetic valve degeneration involves redo open-heart surgery. However, repeat cardiac surgery may be associated with significant morbidity and mortality. With the rapid evolution of transcatheter heart valve therapies, the feasibility and safety of implanting a transcatheter heart valve within a failed tissue valve has been established. We review the historical perspective of transcatheter valve-in-valve therapy, as well as the main procedural challenges and clinical outcomes associated with this new less invasive treatment option.
Topics: Aortic Valve Stenosis; Bioprosthesis; Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve Insufficiency; Outcome Assessment, Health Care; Prosthesis Failure; Reoperation; Transcatheter Aortic Valve Replacement
PubMed: 26516006
DOI: 10.1016/j.jacc.2015.09.015 -
Current Cardiology Reviews 2022Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily...
BACKGROUND
Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily relatively uncommon complications of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences.
OBJECTIVE
Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success.
METHODS
A comprehensive literature search was undertaken to formulate this narrative review.
RESULTS
This review highlights the complex nature of PVL and the promising contemporary treatments available.
CONCLUSION
Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.
Topics: Humans; Aortic Valve; Aortic Valve Insufficiency; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35546743
DOI: 10.2174/1573403X18666220511113310 -
BMJ Case Reports Feb 2016This report describes a case of Campylobacter fetus prosthetic valve infective endocarditis and discusses the subsequent management. Although C. fetus has a tropism for...
This report describes a case of Campylobacter fetus prosthetic valve infective endocarditis and discusses the subsequent management. Although C. fetus has a tropism for vascular endothelium, infective endocarditis has rarely been reported. In this patient, despite initial optimal antimicrobial therapy, valve replacement was ultimately required due to ongoing infectious emboli to the brain in the setting of evidence of vegetation enlargement on echocardiogram. The prosthetic valve was replaced, the patient completed a 6-week course of parenteral antibiotics after surgical intervention and he made a full recovery with no long-term neurological sequelae. This case highlights the fact that despite the relatively low prevalence of C. fetus endocarditis, it is associated with a high degree of mortality and valve replacement is often indicated.
Topics: Aged; Anti-Bacterial Agents; Campylobacter Infections; Campylobacter fetus; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male
PubMed: 26917729
DOI: 10.1136/bcr-2015-212928