Systemic thromboembolic accidents in the early post-operative period in patients with prosthetic valves

Since 1975, of 2328 patients with prosthetic valves, 61 presented one or many systemic thromboembolic accidents (TEA) between the 12th and the 60th day of the post-operative period: 54 cases involved the brain and 14 involved other areas. Although the embolic accident was clinically detectable, EEG and scanner helped in detecting multiple emboli. Clinical history enables us to select high-risk cases: arrhythmias (47 cases), previous TEA (20), prosthetic dysfunction (4). However, several patients have no specific history. Mitral valves present the highest risk. The preventive value of anticoagulant therapy is unquestionable but it does not always prevent TEA, even the recurring type. One can meet all degrees, from the self-resolutive minor TEA up to massive cerebral emboli with severe sequelae. Warning signs include fever, high fibrinogen and HBDH levels. When TEA occurs in the hospital, early detection favours fibrinolytic treatment if there are no contra-indications. Whenever surgery was imminent, we used urokinase (29 cases). Despite better surgical techniques, efficient prostheses and anticoagulant treatment, TEA remain all too frequent as we do not have ideal methods for biological detection and effective prevention.