Document Detail


Etiology of stroke after mechanical heart valve replacement--results from a ten-year prospective study.
MedLine Citation:
PMID:  18751471     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIMS OF THE STUDY: In patients carrying mechanical valve prostheses it is assumed that cardioembolic strokes account for 70 - 90 % of clinically diagnosed thromboembolic complications. The etiology of stroke especially in older patients with mechanical heart valves may thus be multiple and not prosthetic valve-related in a substantial percentage. It was the aim of this prospective study to analyze the etiology of stroke in consecutive patients, who had mechanical heart valve replacement before. METHODS: During a 10-year period, 89 consecutive patients were hospitalized at the authors' institution late (> 90 days) after mechanical valve replacement with definite stroke according to the WHO Monica criteria for stroke registers. RESULTS: CCT or MRI revealed cerebral bleedings in 69 (77.5 %) patients, which were small in 42 (60.9 %), intermediate in 24 (34.8 %), and massive in three (4.3 %). Non-embolic, lacunary infarctions were documented in seven (8 %) and embolic strokes in 13 (17%) patients. According to the findings by CCT/ MRI and duplex sonography of the carotid arteries, stroke was considered atherothrombotic in seven of these 13 patients with embolic strokes (53.8 %). Six of these seven patients (86 %) had recurrent neurologic symptoms. In the other four, prosthesis-related stroke was most likely due to a yet undiagnosed active prosthetic valve endocarditis. In only two (2.3%) of the 89 stroke patients, was etiology probably prosthesis-related. Patients with an INR > 5.0 had ischemic stroke in three, and bleedings in four, patients with an INR < 1.8 ischemic strokes in one, and bleedings in three cases. CONCLUSIONS: In conclusion, the vast majority of strokes after mechanical valve implantation in our cohort study were hemorrhagic rather than ischemic in origin, irrespective of the intensity of the oral anticoagulation. For proper treatment decisions, it is therefore essential to discriminate the underlying etiology of stroke.
Authors:
Cornelia Piper; Detlef Hering; Christoph Langer; Dieter Horstkotte
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  17     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-28     Completed Date:  2009-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  413-7     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. cpiper@hdz-nrw.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Brain Ischemia / complications
Cerebral Hemorrhage / complications
Female
Heart Valve Prosthesis / adverse effects*
Heart Valve Prosthesis Implantation
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Complications*
Prospective Studies
Stroke / etiology*
Tomography, X-Ray Computed
Young Adult

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