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Review
. 2016 Dec;16(12):980-989.
doi: 10.14744/AnatolJCardiol.2016.7486.

A global perspective on mechanical prosthetic heart valve thrombosis: Diagnostic and therapeutic challenges

Mustafa Ozan Gürsoy  1 , Macit Kalçık  2 , Mahmut Yesin  3 , Süleyman Karakoyun  4 , Emrah Bayam  5 , Sabahattin Gündüz  5 , Mehmet Özkan  6
Affiliations
Review

A global perspective on mechanical prosthetic heart valve thrombosis: Diagnostic and therapeutic challenges

Mustafa Ozan Gürsoy et al. Anatol J Cardiol. 2016 Dec.

Abstract

Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of prosthetic valve thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience. In this review, we aimed to summarize the pathogenesis, diagnosis, and management of mechanical prosthetic valve thrombosis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Two-dimensional transthoracic echocardiographic imaging of mitral prosthetic valve thrombosis (arrow) in four-chamber view (a) and increased transvalvular gradients and reduced mitral valve area, as demonstrated by Doppler imaging (b). LA - left atrium; LV - left ventricle; RA - right atrium; RV -right ventricle
Figure 2
Figure 2
Two-dimensional TEE demonstrates a soft thrombotic mass (arrow) attached to the hinge of the prosthesis (a). Real-time three-dimensional transesophageal echocardiography from the left atrial side revealed thrombus (arrows) on the prosthetic mitral valve (a’). The thrombus burden was diminished (arrow) after an initial dose of TT (25 mg TPA), shown by 2-D TEE (b) and 3-D TEE (b’). After the second dose of TT, the thrombus size was completely lysed, shown by 2-D TEE (c) and 3-D TEE (c’). LA - left atrium; LAA - left atrial appendage; LV - left ventricle; TEE - transesophageal echocardiography; tPA - tissue-type plasminogen activator; TT - thrombolytic therapy
Figure 3
Figure 3
Multidetector computed tomography revealed a periprosthetic mass with HU: 65 (favors thrombus), which restricted the mobility of one of the leaflets (a). Volume rendering demonstration of pannus over the removed prosthetic valve (b). HU-Hounsfield unit
Figure 4
Figure 4
Two-dimensional transesophageal echocardiography (TEE) revealed a hyperechogenic circular mass on the left ventricular side of the prosthesis (a). Real-time three-dimensional TEE left atrial (b) and left ventricular (c) views showed circular left ventricular side pannus formation. Postoperative specimen of pannus formation (left ventricular-sided) is demonstrated (d)
Figure 5
Figure 5
Diagnostic and therapeutic algorithm for prosthetic valve thrombosis. CF - cinefluoroscopy; MDCT - multidetector computed tomography; NOPVT - nonobstructive prosthetic valve thrombosis; OPVT - obstructive prosthetic valve thrombosis; TEE - transesophageal echocardiography; TTE - transthoracic echocardiography
See this image and copyright information in PMC

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