[Recurrent systemic arterial embolism in patients with valve prostheses]

The first 400 cases of 1,436 patients undergoing cardiac valve replacement were analysed to determine the clinical features of recurrent systemic embolism. The average follow-up period was 87 months. Three groups of patients were compared: A: 289 cases without embolic complications (72.5 p. 100) B: 78 cases with a single systemic thrombo-embolic event. (TEE) (19,5 p. 100) C: 33 cases with recurrent TEE (8.25 p. 100). The incidence of recurrence is high (30 p. 100 of cases, 8,1 p. 100 per patient year, compared to 3.8 p. 100 for the first TEE). The site of recurrent embolism was the same in 45 p. 100 of cases. The consequences were serious, 30 to 40 p. 100 of events being associated with death or invalidating sequellae. Four factors predisposed to TEE: mitral valve prosthesis, atrial fibrillation, left atrial dilatation and poor anticoagulant control. Fifty-four months after the first TEE, 60 p. 100 with inadequate anticoagulation had a recurrence compared to 20 p. 100 of patients with satisfactory control. Twenty-six patients (Groups B and C) had operative or autopsy examination of the prosthesis: thrombosis was found in 12 out of 18 cases in Group B, and in 7 out of 8 cases in Group C. Reoperation may be necessary to change the valve (27 out of 1,436 patients). Strict adherence to anticoagulant therapy remains the best prophylaxis against TEE and their recurrence.