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Debate - Part 1

Prosthetic Valve Obstruction Thrombolysis Is a Good Option in Majority of Patients

Volume 1, Oct 2012

Sanjeev Gera DNB, Ashok K. Omar, MD, Sameer Shrivastava, MD, DM, New Delhi, India

Prosthetic valve obstruction is rare but a life-threatening complication after cardiac valve replacement associated with significant morbidity and mortality warranting immediate management. Incidence of prosthetic valve thrombosis (PVT) may be as high as 13% in the first year or 20% overall in patients with tricuspid valve prosthesis and 0.2–6% patient per year in left-side prosthesis (1,2). Inadequate anticoagulation is the major contributing factor. Prosthetic vale thrombosis can present either as obstructive PVT or nonobstructive PVT. Acute obstruction leads to acute heart failure or cardiogenic shock or it can be an insidious process with acute thrombosis over pannus formation. Nonobstructive thrombosis may cause stroke or peripheral embolism but 50% may be asymptomatic. Guidelines differ on whether surgical treatment (reoperation or thrombectomy) or thrombolysis should be the treatment of choice since recommendations have largely been based on case reports or series with lack of well-designed prospective randomized trials.


Volume 1, Number 4, Pages: 185-9




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