Obstructive left-sided prosthetic valve thrombosis

Yaron Shapira*, Modrehay Vaturi, Alex Sagie

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Obstructive prosthetic valve thrombosis is a serious complication in patients with prosthetic heart valves. It should be suspected in patients with worsening functional class, embolic phenomena, and inadequate anticoagulation. TTE is very informative and the most frequent modality to begin with. TEE is extremely important, with its unique role in excluding high-risk thrombi. Fluoroscopy is currently the best modality for the assessment of leaflet motion, especially for the aortic position, while cardiac CT may be of added value due to its unique post-processing features. Efforts to discriminate thrombosis from pannus should be made, although current methods are frequently inconclusive. The application of 3-dimensional TEE is hoped to improve the diagnostic accuracy further. Once the diagnosis is established, therapy should be offered according to the local expertise, considering the risk of surgery, the risk of thrombolysis (mainlybleeding and embolism), the patients' functional class, and the likelihood of achieving valve reopening. Guidelines are numerous and puzzling. Thrombus size is probably the most important determinant of complications, and if it is small, thrombolysis is probably advised across all degrees of functional class, as suggested by American College of Chest Physicians.

Original languageEnglish
Pages (from-to)160-168
Number of pages9
JournalAcute Cardiac Care
Volume11
Issue number3
DOIs
StatePublished - 2009

Keywords

  • Prosthetic heart valve
  • Thrombolysis
  • Thrombosis

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