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Surgical management of thrombotic disc valve
1Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Insights
Thrombosis of tilting-disc valve prostheses is a serious complication. Early diagnosis via echocardiography and prompt thrombectomy offer a safe and effective treatment, improving patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Thrombotic obstruction is a rare but life-threatening complication of cardiac valve prostheses, disproportionately affecting tilting-disc designs.
- Diagnosis and surgical management of prosthetic valve thrombosis present significant challenges.
Purpose of the Study:
- To evaluate the clinical features, diagnostic methods, and surgical outcomes of patients with thrombosis of a tilting-disc valve prosthesis.
- To highlight the efficacy of prompt surgical intervention, specifically thrombectomy, in managing this critical condition.
Main Methods:
- Retrospective analysis of ten consecutive patients treated for tilting-disc valve prosthesis thrombosis between November 1982 and August 1990.
- Preoperative clinical assessment, echocardiography, and cardiac catheterization were utilized for diagnosis.
- Surgical interventions included thrombectomy and valve replacement.
Main Results:
- All patients presented with symptoms such as exertional dyspnea, new murmur, or absence of prosthetic valve click.
- Echocardiography accurately diagnosed prosthetic valve malfunction in 90% of cases.
- Prompt reoperation, predominantly thrombectomy (8 patients), resulted in survival for all undergoing this procedure; valve replacement had one death (2 patients).
Conclusions:
- Thrombosis should be considered in patients with mechanical heart valve prostheses presenting with nonspecific symptoms and subtle physical findings.
- Echocardiography is a valuable diagnostic tool for prosthetic valve malfunction.
- Thrombectomy is a safe, rapid, and effective procedure for critically ill patients with prosthetic valve thrombosis.
Abstract:
Thrombotic obstruction, a rare but often fatal complication of cardiac valve prostheses, appears to occur more frequently in tilting-disc valves than in other valve designs. Its diagnosis and surgical treatment remain a challenge. Ten consecutive patients who had thrombosis of a tilting-disc valve prosthesis were treated in Chang Gung Memorial Hospital from November 1982 to August 1990. Preoperative clinical features, including exertional dyspnea, new murmur, and absence of a metallic click from the prosthetic valve, occurred in all of the patients. Symptoms were present for 1 week or more before reoperation in 70% of the patients; nevertheless, many patients were referred only after acute exacerbation of heart failure and development of pulmonary edema. Echocardiography confirmed prosthetic valve malfunction in 90% of the patients. One unconfirmed case was later documented by cardiac catheterization. Anticoagulant therapy was in the therapeutic range for only half of the patients at the time of admission. Prompt reoperation was performed for thrombectomy (8 patients, all survived) or valve replacement (2 patients, one death). Long-term outcome was satisfactory in all survivors with a mean follow-up of 31.6 months. These findings emphasize the importance of considering the diagnosis of thrombosis in patients with mechanical heart valve prostheses who are first seen with nonspecific symptoms and minor changes of their physical findings. The diagnosis could be easily made by echocardiography. Thrombectomy is an easy, fast, and safe procedure, especially for these critically ill patients.