An emergency physician's guide to prosthetic heart valves: Valve-related complications (original) (raw)

Management of the Patient with a Prosthetic Heart Valve

The Annals of Thoracic Surgery, 1976

Approximately 20,000 heart valve pros-cardiac surgery makes it evident that new theses are inserted yearly in the United States. Even methods will have to be developed to cope with after successful heart operations, the patients who these conditions. Unfortunately, this aspect of receive them cannot be regarded as healthy individu-cardiac surgery has been neglected.

Reoperation on prosthetic heart valves

The Journal of Thoracic and Cardiovascular Surgery, 1995

Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. To determine the correlates of hospital events, including in-hospital mortality, new persisting neurologic deficit, and length of postoperative stay, a three-institution study of 2246 consecutive prosthetic valve reoperations performed on 1984 patients between 1963 and 1992 was undertaken. The combined experience ranged from high-risk patients coming moribund to the operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-unadjusted hospital mortality was 10.8%, neurologic deficit at hospital discharge 1.1%, and length of stay 10 days (median). Multivariably determined correlates of outcome included age at reoperation, degree, severity, and acuity of impairment of cardiac function, extensiveness of valvular heart disease, coexisting morbid conditions, number of previous heart operations, and concomitant procedures. The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3% (90% confidence limits 0.3% to 4.4%), neurologic deficit 0.3% (90% confidence limits 0.02% to 1.8%), and length of postoperative stay 7 days (9t)% confidence limits 4 to 13), emphasizing the wide variance in outcome events. Equations were developed to permit wide application of the results of the study for quantitatively estimating the risk of outcome events based on individual preoperative patient characteristics. These estimates should be useful for informed patient consent, considerations of prophylactic valve replacement, and cost and resource use. (J TttORAC CARDIOVASC SURG 1995;109:30-48)

Echocardiographic evaluation of the St. Jude medical prosthetic valve

CHEST Journal, 1981

M-mode 8Ud tw-8s&o8I sddicn were performed on 19 p t k M~ with 25 normaUy fumet i o n i D g S t . J B d c M~~~r r h r c g t .~ r d t e m p t t o d e f i n e t b~e c b~. p p e r c a o c e o f t h i s n e w a r d & c~~Q r y M I . r o d e e c b o c u d b g r e r s w c r e~h 1 7 o f t h e 1 9 ) r t k . t s , and satisfactory twodhedonal studios were obbhed in dl. M-moac mem?arelacnta indrkrl the dbmder ot tbtoridicerfng,k.8etm!pgcctka,andtbeopt.iqrsd cloedng dopes of tbe l d e b . The vr)Pes obbhred conk grams have pnwen to be of M-m"d"value in diagnosing dydumtion of a wide varies of prosthetic cardiac \Falves.14 Before dysfunction can be appreciated, the ~~h i c appearance of normally f d o n i n g valves must be known. We performed M-mode and two-dimsional echocardiopphic studies on all patients who had undergone implantation of a S t Jude Medical prosthetic cardiac valve at our institution, in an attempt to define the n o d txhaudi-fiic appearance of this new cardiac prosthesis. Nineteen patients with 25 normally functioning St. Jude Medid prostbetic cardiac valves were studied at one week to 11 months aher surgery (mean, two muntbs). Ten patients had a prosthetic aortic valve, three had a mitral valve, one had a tricuspid h e , one had a p h o n i c valve, two had both an aortic and a mitral valve, and hm bad prostheses in the aortic, mitrd, and tricaspid positions. The group consisted of eight malo and 11 female patients, m@ng in age from l.2 to 89 years. *From tbe C a r d i 0 2 &+a?, Dsputmsnt of Medicine, and the Thoracic G d m w s a h Surgery Service, Department of Surgery, Tbe opinions and assertha contained herein are the private views of the authors and are not to be ccwstruad as ofl6cial o r a s r e 9 c c t i n g~v i e w s o f t b e~t d t b e A r m y or the Department of Defense. ology Service. Deparrtment of Medicine.

Characteristics of surgical prosthetic heart valves and problems around labeling (1)

Intraoperative surgical prosthetic heart valve (SHV) choice is a key determinant of successful surgery and positive postoperative outcomes. Currently, many controversies exist around the sizing and labeling of SHVs rendering the comparison of different valves difficult. To explore solutions, an expert Valve Labelling Task Force was jointly initiated by the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS). The EACTS-STS-AATS Valve Labelling Task Force, comprising cardiac surgeons, cardiologists, engineers, regulators and representatives from the International Organization for Standardization (ISO), and major valve manufacturers, held its first in-person meeting in February 2018 in Paris, France. This article was derived from the meeting's discussions. The Task Force identified the following areas for improvement and clarification: reporting of physical dimensions and characteristics of SHVs determining and labeling of SHV size, in vivo and in vitro testing, and reporting of SHV hemodynamic performance and thrombogenicity. Furthermore, a thorough understanding of the regulatory background and the role of the applicable ISO standards, together with close cooperation between all stakeholders (including regulatory and standard-setting bodies), is necessary to improve the current situation. Cardiac surgeons should be provided with appropriate information to allow for optimal SHV choice. This first article from the EACTS-STS-AATS Valve Labelling Task Force summarizes the background of SHV sizing and labeling and identifies the most important elements where further standardization is necessary. (J Thorac Cardiovasc Surg 2019;-:1-14)

PROSTHETIC VALVE DYSFUNCTION

African journal of Biological sciences, 2024

Background: Prosthetic heart valve replacement is the commonest choice in case of valvular failure or functional impairment. Although, they are considered to be ideal choices, they are vulnerable to dysfunction depending on various factors. Arising valvular dysfunctions are mostly related to stenosis or regurgitation. Methodology: This is a descriptive study including 30 participants out of which 17 are male and 13 are female. Subjects between 20 and 80 years of age with mitral valve replacement were included in the study with their consent. Subjects with other cardiac complications were excluded. The study was conducted for 12 months in the department of Echocardiography in a private institute for Cardiac sciences. Outcomes were assessed using ECG, ECHO, Catheterisation data, complications, type of valve used and symptoms associated with dysfunction. Results: Hypertension was seen in 50% subjects and mechanical valve was mostly used in subjects about 46.7%. observing the symptoms associated with dysfunction, syncopewas noted majorly in men about 93.3% and dyspnea was commonly seen in women about 63.3%. Dysfunction commonly occurred in 80% men on acitrom medication and 43.3% women on warfarin treatment. Conclusion: In conclusion we report that mechanical valves tend to cause valvular dysfunction alone or when supported by various other factors like use of drugs, comorbidities, social habits, and other cardiac disturbances. Although they are considered to be potentially a greater choice, they still tend to cause dysfunction which hinders the therapeutic progress. Further studies in larger sections need to be conducted to analyse the results more specifically and provide better therapeutic outcomes.

CSI consensus statement on prosthetic valve follow up

Indian Heart Journal, 2012

Dr Yash Lokhandwala, and 10 or more other experts, including non-CSI members wherever additional expertise was thought necessary. The first and second drafts were circulated to the Expert Panel in August and October 2011. The Expert Panel met in December 2011 during the Annual Meeting in Mumbai, and the third draft was presented to CSI in an academic session the next day, with over 3 h of discussion, and their recommendations were incorporated. v Members of Task Force/Writing Committee. w Late.

Sixty-Four–Section Cardiac Computed Tomography in Mechanical Prosthetic Heart Valve Dysfunction

Circulation-cardiovascular Imaging, 2015

T he most common causes of mechanical prosthetic valve dysfunction (PVD) are thrombosis and pannus overgrowth. 1 Transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and fluoroscopy are commonly used in the evaluation of prosthetic heart valves. 2 However, none of these imaging techniques provides an accurate diagnosis of pannus overgrowth without surgical confirmation. 3 See Editorial by Bonnichsen and Pellikka See Clinical Perspective We have recently reported that thrombolytic therapy (TT) should be considered as a first-line treatment in patients with prosthetic valve thrombosis unless contraindicated. 4-6 Two-dimensional and real-time 3-dimensional TEE accurately identify prosthetic valve thrombosis with good sensitivity. 7-11 However, the inability to definitively diagnose pannus is a major drawback of conventional imaging methods, though real-time 3-dimensional TEE may have some value. 12 Pannus has been reported to accompany thrombus in almost half of the cases with prosthetic valve obstruction, 13 whereas it has been reported to occur in isolation in one fifth of cases. 14 It has also been typically found to be a major reason for failed thrombolysis in prosthetic valve thrombosis. 15 Over the past 5 years, a few case reports 16-19 and research studies 20-28 with limited number of patients have been published regarding the use of multidetector computed tomography (MDCT) for the Background-Distinguishing pannus and thrombus in patients with prosthetic valve dysfunction is essential for the selection of proper treatment. We have investigated the utility of 64-slice multidetector computed tomography (MDCT) in distinguishing between pannus and thrombus, the latter amenable to thrombolysis. Methods and Results-Sixty-two (23 men, mean age 44±14 years) patients with suspected mechanical prosthetic valve dysfunction assessed by transesophageal echocardiography were included in this prospective observational trial. Subsequently, MDCT was performed before any treatment was started. Periprosthetic masses were detected by MDCT in 46 patients, and their attenuation values were measured as Hounsfield Units (HU). Patients underwent thrombolysis unless contraindicated, and those with a contraindication or failed thrombolysis underwent surgery. A mass which was completely lysed or surgically detected as a clot was classified as thrombus, whereas a mass which was surgically detected as tissue overgrowth was classified as pannus. A definitive diagnosis could be achieved in 37 patients with 39 MDCT masses (22 thrombus and 17 pannus). The mean attenuation value of 22 thrombotic masses was significantly lower than that in 17 pannus (87±59 versus 322±122; P<0.001). Area under the receiver operating characteristic curve was 0.96 (95% confidence interval: 0.91-0.99; P<0.001), and a cutoff point of HU≥145 provided high sensitivity (87.5%) and specificity (95.5%) in discriminating pannus from thrombus. Complete lysis was more common for masses with HU<90 compared with those with HU 90 to 145 (100% versus 42.1%; P=0.007). Conclusions-Sixty-four slice MDCT is helpful in identifying masses amenable to thrombolysis in patients with prosthetic valve dysfunction. A high (HU≥145) attenuation suggests pannus overgrowth, whereas a lower value is associated with thrombus formation. A higher attenuation (HU>90) is associated with reduced lysis rates.