Prosthetic valve thrombosis is a potentially life-threatening complication associated with high morbidity and mortality. Transthorasic and transoesophageal echocardiography play an important role to the diagnosis and provides incremental information about the optimal treatment strategy, while fluoroscopy and cardiac computed tomography may be of added value. Guidelines differ on whether surgical treatment or fibrinolysis should be the treatment of choice for the management of left-sided prosthetic valve thrombosis and these uncertainties underline the need for further prospective randomized controlled trials. Thrombus size, New York Heart Association functional class of the patient, the possible contraindications, the availability of each therapeutic option and the clinician’s experience are important determinants for the management of prosthetic valve thrombosis.
RoudautRSerriKLafitteS. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart2007; 93: 137–142.
2.
DanielsCJBarbetseasJBoudoulasH. Prosthetic valves. In: ACC (eds) Adult clinical cardiology self-assessment program, version 7. Washington, DC, American College of Cardiology, 2009, book 4, chapter 19, pp. 19.9.1–19.9.25
3.
DeviriESareliPWisenbaughT. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management. J Am Coll Cardiol1991; 17: 646–650.
4.
VahanianABaumgartnerHBaxJ. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J2007; 28: 230–268.
5.
ButchartEG. Antithrombotic management in patients with prosthetic valves: a comparison of American and European guidelines. Heart2009; 95: 430–436.
6.
YinWAlemuYAffeldK. Flow-induced platelet activation in bileaflet and monoleaflet mechanical heart valves. Ann Biomed Eng2004; 32: 1058–1066.
GirdharGBluesteinD. Biological effects of dynamic shear stress in cardiovascular pathologies and devices. Expert Rev Med Device2008; 5: 167–181.
9.
SunJCDavidsonMJLamyA. Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends. Lancet2009; 374: 565–576.
AminianALefebvrePDelmotteP. An unusual case of late bioprosthetic mitral valve thrombosis successfully managed with anticoagulation. Eur J Echocardiogr2008; 9: 399–400.
12.
BarbetseasJNaguehSFPitsavosC. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol1998; 32: 1410–1417.
13.
LaplaceGLafitteSLabèqueJN. Clinical significance of early thrombosis after prosthetic mitral valve replacement: a postoperative monocentric study of 680 patients. J Am Coll Cardiol2004; 43: 1283–1290.
14.
BarbetseasJZoghbiWA. Evaluation of prosthetic valve function and associated complications. Cardiol Clin1998; 16: 505–530.
15.
ZoghbiWAChambersJBDumesnilJG. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound. J Am Soc Echocardiogr2009; 22: 975–1014.
16.
BarbetseasJCrawfordESSafiHJ. Doppler echocardiographic evaluation of pseudoaneurysms complicating composite grafts of the ascending aorta. Circulation1992; 85: 212–222.
17.
BarbetseasJPitsavosCAggeliC. Comparison of frequency of left atrial thrombus in patients with mechanical prosthetic cardiac valves and stroke versus transient ischemic attacks. Am J Cardiol1997; 80: 526–528.
18.
TongATRoudautROzkanM. Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry. J Am Coll Cardiol2004; 43: 77–84.
19.
CapdevilleMLicinaM. Assessment of prosthetic valves. In: SavageRAronsonS (eds) Introperative transesophageal echocardiography. 1st ed.Philadelphia: Lippincott Williams & Wilkins, 2005, pp. 249–269.
20.
SymerskyPBuddeRPDe MolBA. Comparison of multidetector-row computed tomography to echocardiography and fluoroscopy for evaluation of patients with mechanical prosthetic valve obstruction. Am J Cardiol2009; 104: 1128–1134.
BonowROCarabelloBAChatterjeeK. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol2008; 52: e1–e142.
23.
LengyelMHorstkotteDVöllerH. Working Group Infection, Thrombosis, Embolism and Bleeding of the Society for Heart Valve Disease. Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis2005; 14: 567–575.
24.
SalemDNO’GaraPTMadiasC; American College of Chest Physicians. Valvular and structural heart disease: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest2008; 133: 593S–629S.
25.
RoudautRLafitteSRoudautMF. Management of prosthetic heart valve obstruction: fibrinolysis versus surgery. Early results and long-term follow-up in a single-centre study of 263 cases. Arch Cardiovasc Dis2009; 102: 269–277.
26.
Cáceres-LórigaFMPérez-LópezHMorlans-HernándezK. Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients. J Thromb Thrombolysis2006; 21: 185–190.
27.
NagyADénesMLengyelM. Predictors of the outcome of thrombolytic therapy in prosthetic mitral valve thrombosis: a study of 62 events. J Heart Valve Dis2009; 18: 268–275.
28.
KeuleersSHerijgersPHerregodsMC. Comparison of thrombolysis versus surgery as a first line therapy for prosthetic heart valve thrombosis. Am J Cardiol2011; 107: 275–279.
29.
KarthikeyanGMathRSMathewN. Accelerated infusion of streptokinase for the treatment of left-sided prosthetic valve thrombosis: a randomized controlled trial. Circulation2009; 120: 1108–1114.
30.
BitekerMDuranNEGunduzS. Comparing different intravenous thrombolytic treatment regiments in patients with prosthetic heart valve thrombosis under the guidance of serial transesophageal echocardiography: a 15-year study in a single center (TROIA Trial). Circulation2008; 118: S932.
31.
BalasundaramRPKarthikeyanGKothariSS. Fibrinolytic treatment for recurrent left sided prosthetic valve thrombosis. Heart2005; 91: 821–822.
32.
LaurentMLelongBVerhoyeJP. Prolonged heparin and vitamin K antagonist regimen for early non-obstructive thrombosis of mechanical mitral valve prostheses. J Heart Valve Dis2008; 17: 533–541.
33.
LengyelM. Thrombolysis should be regarded as first-line therapy for prosthetic valve thrombosis in the absence of contraindications. J Am Coll Cardiol2005; 45: 325, author reply 326.
34.
BarbetseasJTsiachrisDChrysohoouC.. Paraprosthetic leak unmasked by combined enoxaparin/warfarin therapy for thrombosed mitral valve. Echocardiography2009; 26: 1105–1106.
