Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Dec 26;7(12):875-81.
doi: 10.4330/wjc.v7.i12.875.

Mechanical valve obstruction: Review of diagnostic and treatment strategies

Jason Salamon  1 , Jerson Munoz-Mendoza  1 , Jared J Liebelt  1 , Cynthia C Taub  1
Affiliations
Review

Mechanical valve obstruction: Review of diagnostic and treatment strategies

Jason Salamon et al. World J Cardiol. .

Abstract

Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic evaluation should focus on differentiating prosthetic valve thrombosis (PVT) from pannus formation, as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient's symptoms, valve location, degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively, pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology, epidemiology, diagnostic approach and treatment options for aortic and mitral valve PVO.

Keywords: Echocardiography; Pannus overgrowth; Prosthetic valve obstruction; Prosthetic valve thrombosis; Thrombolysis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Still frames of 3-dimensional transesophogeal echocardiographic rendering of the mechanical bi-leaflet mitral valve as visualized from the left atrial perspective during diastole showing fixed mitral leaflet (arrow).
Figure 2
Figure 2
Gross sample of explanted mechanical mitral valve revealing the transesophogeal echocardiography finding residual organized thrombus, apparent on the mitral valve disc (arrow).
Figure 3
Figure 3
Proposed echocardiographic evaluation for suspected prosthetic mitral valve obstruction. PHT: Pressure half-time; PVO: Prosthetic valve obstruction; PPM: Prosthetic patient mismatch.
Figure 4
Figure 4
Proposed non-invasive evaluation for suspected prosthetic aortic valve obstruction. AT: Acceleration time; ET: Ejection time; PPM: Prosthetic-patient mismatch; CF: Cine fluoroscopy; CT: Computed tomography; PVO: Prosthetic valve obstruction; EOA: Effective orifice area; DVI: Doppler velocity index; AV: Aortic valve.
Figure 5
Figure 5
Proposed non-invasive evaluation for differentiating thrombus from pannus as underlying cause of prosthetic valve obstruction. TEE: Transesophogeal echocardiography; VIR: Video intensity ratio; INR: International normalized ratio.
See this image and copyright information in PMC

References

    1. Deviri E, Sareli P, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management. J Am Coll Cardiol. 1991;17:646–650. - PubMed
    1. Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014; quiz 1082-1084. - PubMed
    1. Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93:137–142. - PMC - PubMed
    1. Vitale N, Renzulli A, Agozzino L, Pollice A, Tedesco N, de Luca Tupputi Schinosa L, Cotrufo M. Obstruction of mechanical mitral prostheses: analysis of pathologic findings. Ann Thorac Surg. 1997;63:1101–1106. - PubMed
    1. Barbetseas J, Nagueh SF, Pitsavos C, Toutouzas PK, Quiñones MA, Zoghbi WA. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998;32:1410–1417. - PubMed