Cine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function

Cardiology ◽  
2020 ◽  
Vol 145 (7) ◽  
pp. 439-445 ◽  
Author(s):  
Charles Hsu ◽  
Katerina Bourganos ◽  
Mohammad A. Zafar ◽  
Steffen Huber ◽  
Joelle Buntin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Prosthetic Valve ◽  
Dimensional Space ◽  
Prosthetic Heart Valve ◽  
Mechanical Valve ◽  
Cardiac Events ◽  
Repeat Surgery ◽  
Valve Thrombosis ◽  
Valve Function ◽  
Cine Ct

Background: After aortic valve replacement (AVR), suspected prosthetic valve dysfunction (mechanical or biological) may arise based on echocardiographic transvalvular velocities and gradients, leading to reoperative surgical intervention being considered. Our experience has found that 4-dimensional (space and time) image reconstruction of ECG-gated computed tomography, termed cine-CT, may be helpful in such cases. We review and illustrate our experience. Methods: Twenty-seven AVR patients operated previously by a single surgeon (who performs >100 AVRs/year) were referred for repeat evaluation of suspected aortic stenosis (AS) based on elevated transvalvular velocities and gradients. The patients were fully evaluated by cine-CT. Results: In all but 2 cases, the cine-CT strikingly and visually confirmed normal leaflet function and excursion, with no valve thrombosis, restriction by pannus, or obstruction by clot. In only 2 cases did cine-CT reveal decreased mechanical valve leaflet excursion. Repeat surgery was required in only 1 case while all other patients continued clinically without cardiac events. Conclusions: Echocardiography is an extraordinarily useful tool for the evaluation of prosthetic valve function. Increased pressure recovery beyond the valve and other factors may occasionally lead to exaggerated gradients. Cine-CT is emerging as an extremely valuable tool for further evaluation of suspected prosthetic valve AS. Our experience has been extremely helpful, as is shown in the dramatically reassuring images.

scholarly journals Thrombolytic therapy in prosthetic valve thrombosis in the second trimester of pregnancy

2020 ◽  
Vol 7 (5) ◽  
pp. 853
Author(s):  
Santhosh Jadhav ◽  
H. S. Natraj Setty ◽  
Shankar S. ◽  
Phani Teja Mundru ◽  
Yeriswamy M. C. ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Mechanical Valve ◽  
Second Trimester ◽  
Prosthetic Valve Thrombosis ◽  
First Line Therapy ◽  
Mechanical Valves ◽  
Valve Thrombosis

Pregnancy with mechanical valves requires anticoagulation, the risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected. Prosthetic valve thrombosis during pregnancy requires immediate therapy such as valve replacement, thrombolytic therapy, or surgical thrombectomy. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. We describe a primigravida (second trimester) with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.

scholarly journals Severe Vascular Complications Following Thrombolytic Therapy in a Case of Prosthetic Mitral Valve Thrombosis – A Case Report

2021 ◽  
Vol 10 (14) ◽  
pp. 1035-1038
Author(s):  
Ayan Husain ◽  
Shilpa Abhay Gaidhane ◽  
Priti Abhay Karadbhajane ◽  
Sourya Acharya ◽  
Apoorva Nirmal
Keyword(s):  
Thrombolytic Therapy ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Vascular Complications ◽  
Mechanical Valve ◽  
Fibrinolytic Therapy ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
Prosthetic Mitral Valve ◽  
Immediate Surgery

Prosthetic cardiac valve thrombosis is a rare but dangerous complication; 1,2 particularly in patients with low conformity on anticoagulant therapy. Thromboembolic problems happen after mechanical valve substitution in 0.5 - 8 percent. 3-5 Fibrinolytic therapy to treat the thrombosis is widely used nowadays with high efficacy and no severe side effects as compared to emergency surgical treatment, which is associated with high mortality.6 Surgical valve repair in patients with rheumatic heart disease remains the gold standard for the treatment. Thrombosis of the prosthetic heart valve in patients undergoing valve replacement, is the most severe and deadly complication. Currently, the treatments available for symptomatic prosthetic valve thrombosis are immediate surgery or thrombolytic therapy (TT). In rural hospital settings patients are poor and there is a lack of surgical expertise. These factors make TT the perfect treatment for prosthetic valve thrombosis. But one should be aware of embolic complications.

Abstract 1120: Chest Pain and Dyspnea in a Pregnant Woman with a Prosthetic Valve

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jameel Ahmed ◽  
George Philippides ◽  
Michael Klein
Keyword(s):  
Chest Pain ◽  
Aortic Valve ◽  
Physical Examination ◽  
Prosthetic Valve ◽  
Mechanical Valve ◽  
Pregnant Female ◽  
Transthoracic Echocardiogram ◽  
Posterior Leaflet ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis

A 31 year old pregnant female at nine weeks gestation presented with a complaint of recurrent chest pain and dyspnea. The patient had undergone aortic valve replacement with a bileaflet mechanical valve at 25 years of age. Most recently, she had been anti-coagulated with low-molecular weight heparin. The patient had missed two doses of enoxaparin over the prior week. Physical examination was notable for muffled, but audible mechanical valve sounds with an early peaking, systolic murmur over the right sternal border. Transthoracic echocardiogram revealed an elevated mean trans-aortic gradient of 38 mm Hg. Of note, echocardiogram at an outside hospital six days earlier had revealed normal gradients. Trans-esophageal echocardiography was performed, which revealed a poorly mobile posterior leaflet without large thrombus, and confirmed elevated gradients. Fluoroscopy of the aortic prosthesis also revealed a fixed posterior leaflet. A presumptive diagnosis of prosthetic valve obstruction (PVO) due to prosthetic valve thrombosis (PVT) was made. After discussion with the patient, intravenous tissue plasminogen activator was administered. Fluoroscopy the following day revealed both aortic valve leaflets to be fully mobile and transthoracic echocardiogram demonstrated normal trans-aortic gradients. Patient was anti-coagulated with enoxaparin until twelve weeks gestation and with coumadin for the duration of her pregnancy. At 37 weeks, a healthy, baby boy was delivered. PVO can be caused by thrombus, pannus formation or endocarditis. PVT is the most common etiology, with an annual rate of 0.5 to 8%. An increase in clotting factors during pregnancy results in a physiologic hypercoagulable state and higher rates of thromboembolic complications. Management options of PVT include surgery or intravenous thrombolytic therapy. Trans-esophageal echocardiography can be used to help guide management. This case illustrates the difficulties in the diagnosis and management of a relatively uncommon condition (prosthetic valve thrombosis) in a common patient (pregnant female). In conjunction with the clinical history and physical examination, various imaging modalities were utilized to arrive at a likely diagnosis and formulate a management plan.

scholarly journals Spontaneous Normalization of Valve Function After Failed Fibrinolytic Therapy for Left-Sided Prosthetic Valve Thrombosis

2015 ◽  
Vol 65 (14) ◽  
pp. 1484-1485 ◽  
Author(s):  
Ganesan Karthikeyan ◽  
Nagendra Boopathy Senguttuvan ◽  
Niveditha Devasenapathy ◽  
Vinay K. Bahl ◽  
Balram Airan
Keyword(s):  
Prosthetic Valve ◽  
Fibrinolytic Therapy ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
Valve Function

scholarly journals Obstructive thrombosis of mitral prosthesis — diagnostic trap during a pandemic

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Diana Lupu ◽  
◽  
Aurel Grosu ◽  
Nadejda Diaconu ◽  
Vitalie Moscalu ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Condition ◽  
Prosthetic Heart Valve ◽  
Mechanical Valve ◽  
Valve Prosthesis ◽  
First Line Therapy ◽  
Valve Thrombosis ◽  
Mitral Prosthesis ◽  
Prosthetic Mitral Valve ◽  
Heart Valve Thrombosis

Prosthetic obstructive thrombosis, being a major emergency, requires the identification of symptoms of heart failure, which are crucial elements in the early diagnosis and initiation of prompt therapeutic management. Adequate clinical, preclinical and instrumental assessment is the key tactic, used both to confirm the diagnosis and to assess the severity of the general condition and the prognosis of survival of the patient with obstructive thrombosis of the valve prosthesis. Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 63-year-old woman who had undergone mitral valve replacement operation 11 months ago, presenting to the guard room in an extremely serious general condition, in polyvisceral and polysystemic dysfunction syndrome (MODS). A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transthoracic echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred.

Unusual presentation of mitral prosthetic heart valve thrombosis managed with low dose tenecteplase infusion

2021 ◽  
pp. 1-3
Author(s):  
A. Shaheer Ahmed ◽  
Shivank Gupta
Keyword(s):  
Prosthetic Valve ◽  
Low Dose ◽  
Prosthetic Heart Valve ◽  
Low Grade ◽  
Prosthetic Valve Thrombosis ◽  
Echocardiographic Evaluation ◽  
Dose Infusion ◽  
Valve Thrombosis ◽  
History Of ◽  
Heart Valve Thrombosis

Abstract A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed echocardiographic evaluation revealed possible prosthetic valve thrombosis, which was confirmed by fluoroscopy. She was thrombolysed with low dose infusion of tenecteplase. Post thrombolysis her symptoms improved, valve mobility was restored, and haemoptysis subsided. Left sided prosthetic valve thrombosis presenting predominantly with haemoptysis is very rare.

The usefulness of cardiac computed tomography in the diagnosis of perivalvular complications in patients with prosthetic valve endocarditis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Zatorska ◽  
T Hryniewiecki ◽  
D Zakrzewski ◽  
M Nieznanska ◽  
M Kusmierczyk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Prosthetic Valve ◽  
Cardiac Computed Tomography ◽  
False Negative ◽  
Prosthetic Valve Endocarditis ◽  
Mechanical Valve ◽  
Inflammatory Infiltration ◽  
Ct System ◽  
Perivalvular Leakage

Abstract Background and purpose of the study Echocardiography remains the gold standard for the diagnosis of prosthetic valve endocarditis (PVE). But in around 15% of cases, its results can be false negative due to the acoustic shadow of artificial valves. The aim of the study was compare cardiac computed tomography (CT) with other imaging modalities in the diagnosis of perivalvular complications in patients with PVE. Material and methods The study included 35 consecutive patients with PVE. Thirty of them had an artificial aortic valve (17- mechanical valve, 13-biological valve), 7-mechanical mitral valve, and one patient was after biological pulmonary valve implantation. Three patients were after aortic and mitral valve replacement. Each patient underwent transthoracic (TTE) and transesophageal (TEE) echocardiography. ECG-gated CT examinations were performed with a dual source CT system. All patients were qualified for surgical treatment. The assessment included the presence of vegetation, perivalvular abscess/pseudoaneurysm, inflammatory infiltration and prosthesis dehiscence. Results Intraoperative assessment revealed the presence of vegetations in 16 patients. The sensitivity of echocardiography (TTE+TEE) and CT examinations was 100% and 93% respectively. Twenty one abscesses/pseudoaneurysms were found intraoperatively. The sensitivity of echocardiography and CT examinations was 76% and 85%, respectively. The analysis of total TTE, TEE and CT findings showed that supplementing echocardiography with CT had increased the sensitivity of the method for detecting abscess/pseudoaneurysms to 95%. In a patient in whom no abscesse was found, inflammatory infiltration was diagnosed in echocardiography. Inflammatory infiltration was diagnosed intraoperatively in 13 patients. The sensitivity of echocardiography and CT was 69% in both examinations. The sensitivity of the combination TTE + TEE + CT was 92%. Perivalvular leakage was found intraoperatively in 17 patients. The sensitivity of echocardiography and CT for the diagnosis of this complication was 100% and 87%, respectively. Conclusions CT is better than echocardiography in diagnosing abscesses/pseudoaneurysms and has the same sensitivity in detecting inflammatory infiltration. Adding CT to echocardiography improves the sensitivity of these complications detection. CT is not superior to echocardiography in the diagnosis of vegetations and perivalvular leakage, but it can be a useful tool when echocardiography findings are inconclusive. Funding Acknowledgement Type of funding source: None

scholarly journals Risk Factors Associated with Heart Valve Thrombosis in Patients with Prosthetic Heart Valve Dysfunction

2020 ◽  
Vol 23 (9) ◽  
pp. 600-604
Author(s):  
Feridoun Noohi Bezanjani ◽  
Sepehr Gohari ◽  
Hossein Ali Bassiri ◽  
Hassan Ahangar ◽  
Tara Reshadmanesh
Keyword(s):  
Heart Valve ◽  
Prosthetic Valve ◽  
Fibrinogen Level ◽  
Laboratory Data ◽  
Prosthetic Heart Valve ◽  
Plasma Fibrinogen ◽  
Plasma Fibrinogen Level ◽  
Valve Thrombosis ◽  
History Of ◽  
Heart Valve Thrombosis

Background: Thrombotic and thromboembolic events are important causes of mortality and morbidity in patients with prosthetic heart valve. The aim of this study is to evaluate the factors that may contribute to prosthetic heart valve thrombosis. Methods: This was a cross-sectional study in Rajaie Heart Center on patients with prosthetic heart valve malfunction, within a year. According to the echocardiographic and fluoroscopic findings, the patients were divided into two groups (thrombosis and non-thrombosis groups). The patients’ demographic, clinical and laboratory data were recorded and analyzed with SPSS software. Results: A total of 142 patients participated in this study. Ninety-four patients (66.2%) were diagnosed with thrombosis. There was a significant relationship between thrombosis and inadequate anti-coagulation (international normalized rati [INR] <2.5) (odds ratio [OR]: 4.15, 95% CI: 1.98-9.87, P = 0.003), history of infection (OR: 12.81, 95% CI: 3.52-19.02, P<0.001), prothrombin time (PT) check interval (OR: 2.38, 95% CI: 1.63-8.47, P = 0.019), atrial fibrillation (AF) rhythm (OR: 3.96, 95% CI: 1.75-8.09, P = 0.019), and plasma fibrinogen level (OR: 6.90, 95% CI: 2.58-14.69). Conclusion: Based on this study, inadequate anti-coagulation, AF rhythm, recent infection and plasma fibrinogen level were the factors most contributing to prosthetic valve thrombosis. As there were many cases of thrombosis in patients with history of infection, this factor can be considered for risk assessment in prosthetic valve.

scholarly journals 1645 Unexpected aortic bioprosthetic valve thrombosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ramos Jimenez ◽  
M Pascual Izco ◽  
A Carvelli ◽  
D Kristo ◽  
R Hinojar Baydes ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Ventricle ◽  
Valve Replacement ◽  
Oral Anticoagulation ◽  
Prosthetic Valve ◽  
Nyha Class ◽  
Bioprosthetic Valve ◽  
Valve Thrombosis ◽  
Left Ventricle Dysfunction

Abstract Introduction Prosthetic valve thrombosis (PVT) is a rare but feared complication of cardiac valve replacement which usually represents a difficult diagnostic challenge. Although PVT is not frequent in bioprosthetic valves, the advent of transcatheter heart valves and the advances in computed tomography, allowing the detection of subclinical thrombosis, have yielded growing interest in that field, specially taking into account that there is no consensus on optimal antithrombotic approach in these patients. Clinical Case A 74-year-old male with prior cardiac antecedents of aortic valve replacement (April 2010) with a bovine pericardial bioprosthesis (Mitroflow 25, Sorin group Inc.), ischemic dilated cardiomyopathy with moderately depressed left ventricle ejection fraction (33%) and carrier of VDD pacemaker due to third degree atrioventricular block was admitted to advanced heart failure unit. During routine follow-up echocardiograms, prosthetic valve presented no signs of dysfunction except slightly increased gradients (image C): max 38 mmHg (normal &lt;36), med 23 mmHg (normal &lt;20). Because of left ventricle dysfunction, high pacing rate (&gt;95%) and dyspnea NYHA class III the patient was referred for upgrade to cardiac resynchronization therapy (CRT). Computed tomography to asses epicardial venous anatomy prior to CRT implant was performed. In addition to venous distribution, it was described a repletion defect in aortic bioprosthetic valve suggestive of leaflet thrombosis (image A). To complete the study the patient underwent a transesophageal echocardiography (TOE) revealing a swallow’s nest shaped hypoechoic occupation of non-coronary and left aortic leaflets (image B), and 3D effective orifice area of 0,9 cm2. Oral anticoagulation was started in association to previously taken acetylsalicylic acid (ASA). Control TOE was performed 3 months after diagnosis showing almost complete resolution of thrombi. During the follow-up a CRT-D was implanted, with significant response in systolic performance, reaching a LVEF of 45%. Interestingly, despite the increase in anterograde aortic flow, progressive decrease of aortic gradients (max 24 mmHg, med 15 mmHg) until normalization was found (image D). Clinical benefit was also patent, being the patient in NYHA class I at the moment. Discusion Valve thrombosis could be difficult to diagnose in the presence of left ventricle dysfunction as gradients shall remain low despite an important compromise in valve motion. We present a case of incidental diagnosis of non-obstructive leaflet thrombosis that was managed conservatively with oral anticoagulation and ASA. The descent in transaortic gradients, moreover taking into account the response to CRT increasing LVEF, indicates that gradients slightly increased or in the upper limit of normality should raise suspicion in valve dysfunction in the presence of decreased LVEF. Abstract 1645 Figure.

scholarly journals Apixaban use in an atrial fibrillation patient with double mechanical heart valves: a case report

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Jae Young Eom ◽  
Je Kyoun Shin ◽  
Chang Hee Kwon
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Heart Valves ◽  
Atrial Fibrillation Patient ◽  
Mechanical Valve ◽  
Mechanical Heart Valves ◽  
Artery Embolism ◽  
Valve Thrombosis

Abstract Background Warfarin is the only approved oral anticoagulant for long-term prophylaxis against valve thrombosis and thromboembolism in patients with mechanical heart valves. To date, apixaban for patients with double (aortic and mitral) mechanical heart valves has not been reported in the literature. Case summary We report the case of a 50-year-old female who underwent double (aortic and mitral) mechanical valve replacement in February 2017. Warfarin was prescribed after mechanical valve replacement. However, she complained of side effects of warfarin, including tingling sensation and numbness of legs, urticaria, skin rash, and nausea and voluntarily stopped taking medication. In December 2018, she was admitted to the emergency room due to ongoing chest pain. Coronary angiogram revealed embolic myocardial infarction at the left circumflex coronary artery. Nevertheless, she continued to refuse to take warfarin after anticoagulant therapy for coronary artery embolism. Given the patient’s objection, we prescribed apixaban 5 mg b.i.d. since February 2019. When she was diagnosed with atrial fibrillation in April 2020, no intracardiac thrombosis was confirmed on computed tomography and electrical cardioversion was performed safely. While on apixaban, no evidence of prosthetic valve thrombosis or thrombo-embolic events was observed during a 24-month period. Conclusion We report the efficacy and safety of apixaban in a patient with atrial fibrillation and double mechanical heart valves for preventing prosthetic valve thrombus and systemic embolism.

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