Advertisement

Prosthetic Valve Thrombosis in the ER

  • Carlos Jerjes-SánchezEmail author
  • David Rodríguez
  • Jathniel Panneflek
  • Francisco Nevarez
  • Claudia Ortiz-Ledesma
  • Jose Manuel Gonzalez-Rayas
Chapter

Abstract

Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The significant morbidity and mortality associated with this condition warrant rapid diagnostic evaluation. However, diagnosis can be challenging, mainly because of variable clinical presentations and the degree of valvular obstruction. Risk factors for PVT include mechanical and bioprosthetic heart valves or patient-related risk factors. Mechanisms related to acute valve thrombosis include surface, hemostatic, and hemodynamic factors. High-clinical suspicion for PVT must be considered in all patients with a history of mitral or aortic valve replacement plus dyspnea, acute cardiogenic pulmonary edema, loss of functional class, or acute thromboembolism. The clinical presentation and physical findings of PVT are highly variable, often depending on the presence of partial or severe PVT, previous left ventricular ejection fraction, or thromboembolism location. Severe obstruction is typically associated with clinical instability, whereas partial obstruction is often an incidental finding or presents itself as minor thromboembolism. Thrombosis of a bioprosthetic valve has a similar clinical presentation to that of mechanical valve thrombosis. A multimodal approach including transthoracic and transesophageal echocardiography and four-dimensional cardiac computed tomographic imaging is mandatory to diagnose and identify thrombus or pannus. Although surgical treatment is usually preferred in cases of severe obstructive PVT, optimal treatment remains controversial. The different therapeutic modalities available for PVT, heparin, thrombolysis, and surgery will be largely influenced by the severity of valvular obstruction, clinical status, surgery risk, and availability. Right-sided prosthetic valve thrombosis is out of the scope of this chapter.

Keywords

Prosthetic valve thrombosis Mechanical valve thrombosis Bioprosthetic valve thrombosis Thrombolysis Oral anticoagulation 

References

  1. 1.
    Reyes-Cerezo E, Jerjes-Sanchez C, Archondo-Arce T, Garcia-Sosa A, Garza-Ruiz A, Ramirez-Rivera A, et al. Fibrinolytic therapy in left side-prosthetic-valve acute thrombosis: in depth systematic review. Arch Cardiol Mex. 2008;78:309–17.PubMedGoogle Scholar
  2. 2.
    Puri R, Auffret V, Rodés-Cabau J. Bioprosthetic valve thrombosis. J Am Coll Cardiol. 2017;69:2193–211.CrossRefGoogle Scholar
  3. 3.
    Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93:137–42.CrossRefGoogle Scholar
  4. 4.
    Krishnan S. Prosthetic heart valve thrombosis: diagnosis and newer thrombolytic regimes. J Pract Cardiovasc Sci. 2016;2:7.CrossRefGoogle Scholar
  5. 5.
    Dangas GD, Weitz JI, Giustino G, Makkar R, Mehran R. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670–89.CrossRefGoogle Scholar
  6. 6.
    Jerjes-Sanchez C, Rodriguez D, Navarrete A, Parra-Cantu C, Joya-Harrison J, Vazquez E, et al. Inferior vena cava filters in pulmonary embolism. A historic controversy. Arch Cardiol Mex. 2017;87:155–66.PubMedGoogle Scholar
  7. 7.
    Moss AJ, Dweck MR, Dreisbach JG, Williams MC, Mak SM, Cartlidge T, et al. Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction. Open Heart. 2016;3:e000494.CrossRefGoogle Scholar
  8. 8.
    Aladmawi MA, Pragliola C, Vriz O, Galzerano D. Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves. J Thorac Dis. 2017;9:S343–8.CrossRefGoogle Scholar
  9. 9.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e1159–95.CrossRefGoogle Scholar
  10. 10.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Instituto de Cardiología y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnológico de MonterreySan Pedro Garza GarcíaMéxico
  2. 2.Centro de Investigación Biomédica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina, Tecnológico de MonterreySan Pedro Garza GarcíaMéxico
  3. 3.Universidad de MontemorelosMontemorelosMéxico
  4. 4.Escuela de Medicina y Ciencias de la Salud, Tecnológico de MonterreyMonterreyMéxico

Personalised recommendations