Document Detail


Bioprosthetic mitral valve thrombosis: clinical profile, transesophageal echocardiographic features, and follow-up after anticoagulant therapy.
MedLine Citation:
PMID:  8887873     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cardiac bioprosthetic valve thrombosis is frequently found on pathologic examination, but preoperative diagnosis is rarely performed. Four hundred six patients with mitral porcine xenograft bioprostheses were examined by transthoracic echocardiography. Transesophageal echocardiography (TEE) was performed in 161 of the patients, with clinical or echocardiographic criteria of prosthetic malfunction. Fairly homogeneous and echodense masses, attached to the ventricular surface of the mitral bioprosthetic cusps, were detected by TEE in 15 patients. Only 10 patients, in whom diagnosis of bioprosthetic thrombosis was confirmed, are included in this study. After TEE, two patients underwent prosthetic replacement and eight patients received anticoagulants. A new TEE was performed 85.6 +/- 29.8 days after anticoagulation in these eight patients. Clinical follow-up was continued for 13.6 +/- 8.6 months, and one additional patient underwent surgery during the follow-up. Pathologic examination of removed grafts (three cases) identified these masses as being thrombotic tissue. TEE examination after therapeutic anticoagulation demonstrated complete disappearance of the echogenic masses on bioprosthetic cusps and normal mobility of all leaflets in six cases. In the other two cases, cusp masses were notably reduced, but partially restrictive mobility of affected leaflets persisted, suggesting incomplete resolution of thrombi. Mitral valve prosthetic mean gradient decreased from 11.8 +/- 4.5 to 7.6 +/- 3.7 mm Hg (p < 0.001), and mitral valve area increased from 1.13 +/- 0.3 to 1.72 +/- 0.6 cm2 (p < 0.001). Long-term symptomatic improvement after anticoagulation was obtained in seven patients. Thus this study shows that mitral bioprosthetic thrombosis is a relatively frequent cause of valve dysfunction, TEE is useful for detecting thrombus in relation to mitral bioprosthetic valves, and oral anticoagulation is effective in resolving thrombosis on bioprostheses.
Authors:
J M Oliver; P Gallego; A Gonzalez; F J Dominguez; C Gamallo; J M Mesa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  9     ISSN:  0894-7317     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:    1996 Sep-Oct
Date Detail:
Created Date:  1997-02-12     Completed Date:  1997-02-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  691-9     Citation Subset:  IM    
Affiliation:
Department of Cardiology, La Paz General Hospital, Autonoma University, Madrid, Spain.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / therapeutic use*
Bioprosthesis*
Echocardiography
Echocardiography, Transesophageal*
Female
Follow-Up Studies
Heart Valve Prosthesis*
Humans
Male
Middle Aged
Prosthesis Failure*
Reoperation
Thrombosis / therapy*,  ultrasonography*
Warfarin / therapeutic use
Chemical
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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