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Mechanical valve dysfunction in yemen.
A Raboi1, A Al-Motarreb, A Al-Kanadi
1Cardiac Centre, Al-Thawrah Hospital, Faculty of Medicine, Sana'a University, Yemen.
Heart Views : the Official Journal of the Gulf Heart Association
|December 29, 2010
Summary
Mechanical valve obstruction is a significant problem in Yemen, leading to high mortality. Improving patient education and access to anticoagulant monitoring are crucial to prevent this complication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- Rheumatic heart disease is prevalent in Yemen, with valve replacement being a common cardiac surgery.
- Mechanical valves are associated with serious complications like thrombosis, leading to high mortality.
- Redo open-heart surgery carries a significant mortality risk, especially in critically ill patients.
Purpose of the Study:
- To investigate the incidence and causes of mechanical valve obstruction in Yemeni patients.
- To analyze the outcomes of reoperations for obstructive mechanical valves.
Main Methods:
- A retrospective analysis of 2794 prosthetic valve replacements performed between 2003 and 2007.
- 129 patients (4.6%) underwent reoperation for obstructive mechanical valves.
- Diagnosis was confirmed via echocardiography; patients presented with heart failure, often in NYHA class IV.
Main Results:
- Thrombus was the primary cause of obstruction (86%), followed by pannus formation and vegetation.
- The in-hospital mortality rate for these urgent reoperations was 17.8%.
- Mitral valve prostheses were most frequently affected.
Conclusions:
- Prosthetic valve obstruction is a serious issue in Yemen, linked to limited access to regular INR monitoring.
- Recommendations include enhanced patient education, free INR testing, and provision of anticoagulants.
- Consideration of tissue valves over mechanical valves is suggested in areas with poor medical care access.
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