Mechanical cardiac valve thrombosis in patients in critical hemodynamic compromise

• Published in: European journal of cardio-thoracic surgery Vol. 11; no. 4; pp. 710 - 713
• Main Authors: Buttard, P, Bonnefoy, E, Chevalier, P, Marcaz, P B, Robin, J, Obadia, J F, Kirkorian, G, Touboul, P
• Format: Journal Article
• Language: English
• Published: Germany Elsevier Science B.V 01.04.1997
• Subjects: Adult; Aged; Aortic Valve - surgery; Cerebrovascular Disorders - diagnosis; Cerebrovascular Disorders - mortality; Cerebrovascular Disorders - physiopathology; Cerebrovascular Disorders - surgery; Diagnosis, Differential; Female; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - surgery; Heart Valve Prosthesis; Hemodynamics - physiology; Humans; Male; Middle Aged; Mitral Valve - surgery; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - surgery; Postoperative Complications - diagnosis; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Prosthesis Failure; Reoperation; Survival Rate; Thrombosis - diagnosis; Thrombosis - mortality; Thrombosis - physiopathology; Thrombosis - surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(96)01133-5

BACKGROUND: Valve obstruction is a life threatening complication ofmechanical valve prosthesis. METHODS: From 1985 to 1993, 29 consecutivepatients were hospitalized in our intensive care unit for mechanicalprosthetic valve thrombosis (PVT). There were 12 men and 17 women aged25-75 years (57 +/- 12). Prosthetic valve location was mitral in 14patients, aortic in 6, aortic and mitral in 9. PVT occurred from 15 days to174 months (67 +/- 52 months) after surgery. Delay from first symptoms tohospitalization ranged from 1 to 45 days (11 +/- 11). RESULTS: Firstclinical symptoms were progressive left heart failure in 17 patients,stroke in 6, and chest pain in 6. Furthermore, acute myocardial infarctionwas later documented in 3. Left heart failure NYHA III-IV was present in 26patients (90%) on admission and 10 of those were in cardiogenic shock.Anticoagulation regimen was inadequate in 13 cases (45%). It has beenrecently stopped in 8 patients and incorrectly conducted in 5. Totalhospital mortality was 41.3% (12). It was independent of type and positionof the valve prosthesis. Diagnosis of PVT was only made at autopsy in 3patients who died of recurrent myocardial infarction (2) or cardiogenicshock (1). Five further patients died before any surgery could be attempted(cardiac arrest: 2, cardiogenic shock: 3). Valve replacement could be donein 21 cases, 7 of whom were in cardiogenic shock and 9 had severe pulmonaryedema. Four patients died after surgery, the operative mortality was 19%.CONCLUSION: PVT remains a serious complication of mechanical heart valveprostheses. Overall mortality rate is high, related to difficulty todiagnosis, delay to hospitalization and severe clinical condition atadmission. In our study, operative risk remained acceptable even when theclinical presentation was severe.