Diagnosis, treatment & management of prosthetic valve thrombosis: the key considerations.
Sabahattin GündüzMacit KalcikMustafa Ozan GursoyAhmet GunerMehmet ÖzkanPublished in: Expert review of medical devices (2020)
Introduction: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.Areas covered: The etiopathogenesis, diagnosis, and management of prosthetic heart valve thrombosis with particular focus on conventional and esoteric predisposing factors, diagnosis with multimodality imaging and current therapeutic approaches were covered.Expert opinion: Subtherapeutic anticoagulation remains the key driving force for the development of prosthetic valve thrombosis. However, cardiologists should be cognizant of other frequent or rare conventional and esoteric causes. The diagnosis is now more straightforward with the use of multimodality imaging. Transthoracic and transesophageal echocardiography with or without real-time three-dimensional imaging are the current gold standard modalities. Multidetector computed tomography is now a major complementary tool. The favorable clinical outcomes with recently introduced slow or ultra-slow infusions of alteplase, as compared to relatively poor surgical results, have rendered thrombolytic therapy the first-line treatment option in most eligible patients with prosthetic valve thrombosis. Surgical treatment could be reserved in whom thrombolytic therapy is contraindicated or has already failed. The efficacy and safety of thrombolytic therapy as compared to surgery should be confirmed with large observational cohorts, and ideally randomized trials.
Keyphrases
- pulmonary embolism
- aortic valve
- mitral valve
- computed tomography
- aortic stenosis
- high resolution
- atrial fibrillation
- transcatheter aortic valve replacement
- minimally invasive
- acute ischemic stroke
- heart failure
- ejection fraction
- coronary artery bypass
- magnetic resonance imaging
- cross sectional
- stem cells
- photodynamic therapy
- clinical practice
- mesenchymal stem cells
- magnetic resonance
- left atrial appendage
- mass spectrometry
- surgical site infection
- contrast enhanced