Symptomatic mechanical heart valve thrombosis: high morbidity and mortality despite successful treatment options.

Détails

Ressource 1Télécharger: smw.2001.09685.pdf (352.62 [Ko])
Etat: Public
Version: Final published version
ID Serval
serval:BIB_A54987B2D8B2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Symptomatic mechanical heart valve thrombosis: high morbidity and mortality despite successful treatment options.
Périodique
Swiss medical weekly
Auteur⸱e⸱s
Bollag L., Attenhofer Jost C.H., Vogt P.R., Linka A.Z., Rickli H., Oechslin E., Prêtre R., Dubach P., Turina F., Jenni R.
ISSN
1424-7860 (Print)
ISSN-L
0036-7672
Statut éditorial
Publié
Date de publication
10/03/2001
Peer-reviewed
Oui
Volume
131
Numéro
9-10
Pages
109-116
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Recommendations for treatment of mechanical prosthetic heart valve thrombosis (PVT) include systemic thrombolysis and/or reoperation. Data on complications and outcome are limited.
Clinical and echocardiographic findings of 17 patients with mechanical PVT were reviewed. Complications and outcome of surgery and/or thrombolysis were analysed. Prospective follow-up was obtained.
Symptomatic PVT occurred 8.4 +/- 7.2 years after mechanical valve replacement at mean age 55 +/- 15 years. Thrombosis involved the mitral valve in 12 patients (71%), the aortic valve in 4 (24%) and the tricuspid valve in one (6%). The reason for PVT was inadequate anticoagulation in 11 patients (65%), endomyocardial fibrosis in 2 (12%) and unknown in 4 (24%). Prior to diagnosis, systemic emboli occurred in 6 patients (35%). Thirteen patients (76%) presented in functional class NYHA IV. Haemodynamic valve obstruction was documented by echocardiography in 15 patients (88%). Treatment included primary reoperation in 12 patients (71%), thrombolysis with urokinase in 3 (18%) (with reoperation in 1), reinstitution of adequate anticoagulation in one (6%); death occurred before treatment in one (6%). Intraoperatively, both pannus and thrombus were found in 5 of 13 patients (38%). Treatment-related emboli occurred in 5 patients (29%), to the brain in 3, to the legs in one and to a coronary artery in one. Five patients died (mortality 29%) within 30 days due to multiorgan failure/septicaemia (3 patients), congestive heart failure (1), or cerebral emboli (1). Follow-up after 28 +/- 28 months in the 12 surviving patients was unremarkable.
The most common aetiology for obstructive PVT is thrombus formation due to inadequate anticoagulation. PVT remains a serious complication with high morbidity and mortality despite aggressive treatment by thrombolysis and/or surgery. Surgery is often needed due to the frequent presence of pannus and/or large thrombi. However, long-term prognosis after successful treatment of PVT is excellent.

Mots-clé
Adult, Aged, Aortic Valve, Echocardiography, Female, Heart Valve Diseases/complications, Heart Valve Diseases/mortality, Heart Valve Diseases/therapy, Heart Valve Prosthesis/adverse effects, Humans, Male, Middle Aged, Mitral Valve, Retrospective Studies, Thrombosis/complications, Thrombosis/mortality, Thrombosis/therapy, Treatment Outcome, Tricuspid Valve
Pubmed
Web of science
Création de la notice
16/12/2014 17:23
Dernière modification de la notice
20/08/2019 15:10
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