Management of Mechanical Prosthetic Heart Valve Thrombosis

被引:15
|
作者
Jimenez, Cesar E. Soria [1 ]
Papolos, Alexander I. [1 ,2 ]
Kenigsberg, Benjamin B. [1 ,2 ]
Ben-Dor, Itsik [3 ]
Satler, Lowell F. [3 ]
Waksman, Ron [3 ]
Cohen, Jeffrey E. [4 ]
Rogers, Toby [3 ,5 ,6 ]
机构
[1] MedStar Washington Georgetown Univ Hosp Ctr, Div Cardiol, Washington, DC USA
[2] MedStar Washington Hosp Ctr, Dept Crit Care Med, Washington, DC USA
[3] MedStar Washington Hosp Ctr, Sect Intervent Cardiol, Washington, DC USA
[4] MedStar Washington Hosp Ctr, Dept Cardiac Surg, Washington, DC USA
[5] Natl Heart Lung & Blood Inst, Cardiovasc Branch, Div Intramural Res, NIH, Bethesda, MD USA
[6] MedStar Washington Hosp Ctr, 110 Irving St NW,Suite 4B1, Washington, DC 20010 USA
关键词
diagnosis; imaging; mechanical valve; surgery; thrombosis; transcatheter; MOLECULAR-WEIGHT HEPARIN; MITRAL-VALVE; THROMBOLYTIC THERAPY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; CLOSING ANGLES; RECOMMENDATIONS; OBSTRUCTION; PREGNANCY;
D O I
10.1016/j.jacc.2023.03.412
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomog-raphy, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Trans -catheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation. (J Am Coll Cardiol 2023;81:2115-2127) & COPY; 2023 by the American College of Cardiology Foundation.
引用
收藏
页码:2115 / 2127
页数:13
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