Surgical Outcome of Prosthetic Heart Valve Obstruction: Single Center Experience

DOI: 10.4236/wjcs.2012.24016   PDF   HTML     4,313 Downloads   6,478 Views  


Objective: Valve thrombosis defined as any thrombus not caused by infection attached to or near an operated valve that occludes part of the blood flow path and interferes with valve function. Treatment modalities are thrombolytic therapy, surgical thrombectomy and debridement, or re-replacement. The aim of this study is to review our experience in surgical thrombectomy and debridement for obstructed mechanical valve prosthesis, and the impact of the procedure on the outcome in comparison to re-replacement; Methods: The study was conducted retrospectively between 1995 to 2012 in Department of Cardiothoracic surgery, cardiology and internal medicine, Zagazig University Hospital. 92 patients with stuck valve were divided into two groups. Group (A): 54 patients with re replacement and Group (B): 38 patients treated by thrombectomy and debridement; Results: 92 patients with stuck valves the mean age was 38.4(±9.2), 68 male and 85 female in both groups. The large numbers of cases were mitral valve 35 (64.8%) patients in group A and 22 (57.9%) patients in group B, aortic malfunction in group A was 11 (20.4%)patients and 9 (23.7%) cases in group B, double valve malfunction was rare represent 8 (14.8%) and 7 (18.4%)cases in group A and group B respectively; Conclusion: We conclude that thrombectomy and debridement for malfunctioning mechanical valve is a safe, easy and rapid procedure to perform in some cases to avoid the risk of re replacement.

Share and Cite:

A. Brik, A. Salem, N. Talat and A. Shoukry, "Surgical Outcome of Prosthetic Heart Valve Obstruction: Single Center Experience," World Journal of Cardiovascular Surgery, Vol. 2 No. 4, 2012, pp. 81-85. doi: 10.4236/wjcs.2012.24016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] D. Horstkotte and D. Burckhardt, “Prosthetic Valve Thrombosis,” Journal of Heart Valve Disease, Vol. 4, No. 2, 1995, pp. 141-153.
[2] C. W. Akins, D. C. Miller, M. I. Turina, N. T. Kouchoukos, E. H. Blackstone, G. L. Grunkemeier, J. J. M. Takkenberg, T. E. David, E. G. Butchart, D. H. Adams, D. M. Shahian, S. Hagl, J. E. Mayer and B. W. Lytle, “Guidelines for Reporting Mortality and Morbidity after Cardiac Valve Interventions,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 135, 2008, pp. 732-738. doi:10.1016/j.jtcvs.2007.12.002
[3] P. Buttard, E. Bonnefoy, P. Chevalier, P. B. Marcaz, J. Robin, J. F. Obadia, P. Touboul and G. Kirkorian, “Mechanical Cardiac Valve Thrombosis in Patients in Critical Hemodynamic Compromise,” European Journal Cardio-Thoracic Surgery, Vol. 11, No. 4, 1997, pp. 710-713. doi:10.1016/S1010-7940(96)01133-5
[4] M. T. Hagley, A. Lopez-Candales, K. J. Phillips, B. B. Daily and N. T. Kouchoukos, “Thombosis of Mitral Valve Bioprostheses in Patients Requiring Circulatory Assistance,” The Annals of Thoracic Surgery, Vol. 60, No. 6, 1995, pp. 1814-1816. doi:10.1016/0003-4975(95)00627-3
[5] A. Ranzulli, F. Onorati, M. DeFeo, N. Vitale, S. Esposito, L. Agozzino, G. Santarpino, P. Mastroroberto, A. R. Marchese, L. D. Luca, M. Scardone and M. Cotrufo, “Mechanical Valve Thrombosis: A Tailored Approach for a Multiplex Disease. Journal of Heart Valve Disease, Vol. 13, No. 1, 2003, pp. S37-S42.
[6] P. D. Stein, H. I. Bussey, J. E. Dalen and A. G. G. Turpie, “Antithrombotic Therapy in Patients with Mechanical and Biological Prosthetic Heart Valves,” Chest, Vol. 119, No. 1, 2001, pp. 220s-226s. doi:10.1378/chest.119.1_suppl.220S
[7] D. Horstkotte, H. Schulte, W. Bircks and B. E. Strauer, “Lower Intensity Anticoagulation Therapy Results in Lower Complication Rates with the St. Jude Medical Prostheses,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 107, No. 4, 1994, pp. 1136-1145.
[8] A. C. Fiore, H. B. Barner, M. T. Swartz, L. R. McBride, A. J. Labovitz, K. J. Vaca, J. St. Vrain, G. L. Grunkemeier and G. C. Kaiser, “Mitral Valve Replacement: Randomized Trial of St. Jude and Medtronic Hall prostheses,” The Annals of Thoracic Surgery, Vol. 66, No. 3, 1998, pp. 707-713. doi:10.1016/S0003-4975(98)00670-5
[9] S. Robert, A. Raymond, P. Jobn, J. Micheal, W. William and A. Eugene, “Prosthetic Heart Valve Thrombosis: An Overview,” Wisconsin Medical Journal, Vol. 101, No. 7, 2002, pp. 67-69.
[10] B. Kogon, P. H. Kirshbom, J. M. Forbess and K. R. Kanteret, “Thrombolytic Therapy for Progressive Valve Thrombosis in Children: Two Case Reports and Review of Literature,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 127, No. 5, 2004, pp. 1519-1522. doi:10.1016/j.jtcvs.2003.11.026
[11] J. Barbetseas, S. F. Nagueh, C. Pitsavos, P. K. Toutouzas, M. A. Qui?ones and W. A. Zoghbi, “Differentiating Thombus from Pannus Formation in Obstructed Mechanical Prosthetic Valves: An Evaluation of Clinical, Transthoracic and Transesophageal Echocardiographic Parameters,” Journal of the American College of Cardiology, Vol. 32, No. 5, 1998, pp. 1410-1417. doi:10.1016/S0735-1097(98)00385-4
[12] A. A. Aroussi, I. M. Sami and A. Leguerrier, “The Blower: A Useful Tool to Complete Thrombectomy of the Mechanical Thrombotic Valve,” The Annals of Thoracic Surgery, Vol. 81, No. 5, 2006, pp. 1911-1912. doi:10.1016/j.athoracsur.2005.02.070
[13] M. Lengyel, V. Fuster, M. Keltai, R. Roudaut, H. D. Schulte, J. B. Seward, J. H. Chesebro and A. G. Turpie, “Guidelines for Management of Left-Sided Prosthetic Valve Thrombosis: A Role for Thrombolytic Therapy. Consensus Conference on Prosthetic Valve Thrombosis,” Journal of the American College of Cardiology, Vol. 30, No. 6, 1997, pp. 1521-1526. doi:10.1016/S0735-1097(97)00345-8
[14] H. Silber, S. S. Khan, J. M. Matloff, A. Chaux, M. DeRobertis and R. Gray, “The St. Jude Valve Thrombolysis as the First Line of Therapy for Cardiac Valve Thrombosis,” Circulation, Vol. 87, No. 1, 1993, pp. 30-37. doi:10.1161/01.CIR.87.1.30
[15] G. J. Kontos, H. V. Schaff, T. A. Orszulak, F. J. Puga, J. R. Pluth and G. K. Danielson, “Thrombotic Obstruction of Disc Valves: Clinical Recognition and Surgical Management,” The Annals of Thoracic Surgery, Vol. 48, No. 1, 1989, pp. 60-65. doi:10.1016/0003-4975(89)90177-X
[16] P. Venugopal, U. Kaul, K. S. Lyer, I. M. Rao, A. Balram, B. Das, A. Sampathkumar, S. Mukherjee, M. Rajani and H. S. Wasir, “Fate of thrombectomizedbjor Shiley Valves: A Long-Term Cinefluoroscopic, Chocardiographic and Hemodynamic Evaluation,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 91, No. 2, 1986, pp. 168-173.
[17] D. Hering, C. Piper and D. Horstkotte, “Management of Prosthetic Valve Thrombosis,” European Heart Journal, Vol. 17, 2001, pp. 646-650.
[18] N. Vitale, A. Renzulli, F. Cerasuolo, A. Caruso, M. Festa, L. de Luca and M. Cotrufo, “Prosthetic Valve Obstruction: Thrombolysis versus Operation,” The Annals of Thoracic Surgery, Vol. 57, No. 2, 1994, pp. 365-370. doi:10.1016/0003-4975(94)90998-9
[19] E. Deviri, P. Sareli, T. Wisenbaugh and S. L. Cronje, “Obstruction of Mechanical Heart Valve Prosthesis: Clinical Aspects and Surgical Management,” Journal of the American College of Cardiology, Vol. 17, No. 3, 1991, pp. 646-650. doi:10.1016/S0735-1097(10)80178-0
[20] Z. A. Ashour, H. A. Shawky and M. H. Hussein, “Outcome of Pregnancy in Women with Mechanical Valves,” Texas Heart Institute Journal, Vol. 27, No. 3, 2000, pp. 240-245.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.