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Obstructive left-sided prosthetic valve thrombosis

Yaron Shapira1, Modrehay Vaturi, Alex Sagie

  • 1The Dan Sheingarten Echocardiography Unit and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel. yshapira@post.tau.ac.il

Acute Cardiac Care
|June 30, 2009
PubMed

Insights

Prosthetic valve thrombosis requires prompt diagnosis using imaging like echocardiography. Small thrombi may benefit from thrombolysis, guided by guidelines and patient factors.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Obstructive prosthetic valve thrombosis is a serious complication.
  • It presents with worsening functional class, embolic events, and poor anticoagulation.

Purpose of the Study:

  • To review diagnostic modalities for prosthetic valve thrombosis.
  • To discuss therapeutic strategies based on diagnosis and patient risk.

Main Methods:

  • Transthoracic echocardiography (TTE) for initial assessment.
  • Transesophageal echocardiography (TEE) for high-risk thrombi.
  • Fluoroscopy for leaflet motion (aortic position).
  • Cardiac CT for additional data.
  • Distinguishing thrombosis from pannus is challenging.

Main Results:

  • TTE is the initial imaging modality.
  • TEE is crucial for excluding high-risk thrombi.
  • Fluoroscopy excels in assessing aortic valve leaflet motion.
  • 3D TEE may enhance diagnostic accuracy.
  • Thrombus size is a key factor in complication risk.

Conclusions:

  • Prompt diagnosis of prosthetic valve thrombosis is essential.
  • Therapy selection involves surgery vs. thrombolysis, considering risks.
  • Small thrombi may warrant thrombolysis across functional classes, per guidelines.

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