Diagnosis and treatment of left-sided prosthetic valve thrombosis

Abstract

Left-sided prosthetic valve thrombosis is a life-threatening complication of the mechanical valves. Prosthetic valve thrombosis has been divided into obstructive forms (OPVT) and nonobstructive forms (NOPVT). Clinical presentation of OPVT is heart failure and systemic embolism of OPVT and NOPVT, but it may be asymptomatic. Transesophageal echocardiography is the technique of choice for diagnosis and treatment guidance. There are three treatment options. Surgery carries a high hospital mortality risk in severely sick patients. Thrombolysis has been successful in 80%, with a mortality of 4%, depending on obstruction and functional class. Embolic complications were 8-10% depending on obstruction, but not on thrombus size. Heparin treatment has been successful only in NOPVT, if thrombus diameter of less than 5 mm. Based on the latest evidence, thrombolysis should be first-line therapy if there are no contraindications, regardless of obstruction and functional class, if thrombus diameter is greater than, or equal to, 5 mm.