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Review
. 2023 May 30;81(21):2115-2127.
doi: 10.1016/j.jacc.2023.03.412.

Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week

César E Soria Jiménez  1 , Alexander I Papolos  2 , Benjamin B Kenigsberg  2 , Itsik Ben-Dor  3 , Lowell F Satler  3 , Ron Waksman  3 , Jeffrey E Cohen  4 , Toby Rogers  5
Affiliations
Review

Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week

César E Soria Jiménez et al. J Am Coll Cardiol. .

Abstract

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 tomography, 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. Transcatheter 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.

Keywords: diagnosis; imaging; mechanical valve; surgery; thrombosis; transcatheter.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Waksman has served on advisory boards of Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, and Pi-Cardia Ltd; has been a consultant for Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd, Swiss Interventional Systems/SIS Medical AG, Transmural Systems, and Venous MedTech; has received institutional grant support from Amgen, Biotronik, Boston Scientific, Chiesi, Medtronic, and Philips IGT; and is an investor in MedAlliance and Transmural Systems. Dr Rogers has been a consultant and physician proctor for Medtronic, Edwards Lifesciences, and Boston Scientific; has served on advisory boards of Medtronic and Boston Scientific; and holds equity interest in Transmural Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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