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Titolo:
Symptomatic mechanical heart valve thrombosis: high morbidity and mortality despite successful treatment options
Autore:
Bollag, L; Fost, CHA; Vogt, PR; Linka, AZ; Rickli, H; Oechslin, E; Pretre, R; Dubach, P; Turina, F; Fenni, R;
Indirizzi:
Univ Zurich Hosp, Div Cardiol, CH-8091 Zurich, Switzerland Univ Zurich Hosp Zurich Switzerland CH-8091 CH-8091 Zurich, Switzerland Kantonsspital St Gallen, Div Cardiol, St Gallen, Switzerland KantonsspitalSt Gallen St Gallen Switzerland l, St Gallen, Switzerland Kantonsspital Chur, Div Cardiol, Chur, Switzerland Kantonsspital Chur Chur Switzerland hur, Div Cardiol, Chur, Switzerland Univ Zurich Hosp, Dept Cardiovasc Surg, CH-8091 Zurich, Switzerland Univ Zurich Hosp Zurich Switzerland CH-8091 CH-8091 Zurich, Switzerland
Titolo Testata:
SWISS MEDICAL WEEKLY
fascicolo: 9-10, volume: 131, anno: 2001,
pagine: 109 - 116
SICI:
1424-7860(20010310)131:9-10<109:SMHVTH>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
THROMBOLYTIC THERAPY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; FOLLOW-UP; MANAGEMENT; OBSTRUCTION; REPLACEMENT; PROSTHESES; DIAGNOSIS;
Keywords:
prosthetic valve thrombosis; thrombolysis; surgery; complications; treatment; outcome; emboli; pannus;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Fost, CHA Univ Zurich Hosp, Div Cardiol, Ramistr 100, CH-8091 Zurich, Switzerland Univ Zurich Hosp Ramistr 100 Zurich Switzerland CH-8091 zerland
Citazione:
L. Bollag et al., "Symptomatic mechanical heart valve thrombosis: high morbidity and mortality despite successful treatment options", SWISS MED W, 131(9-10), 2001, pp. 109-116

Abstract

Background: Recommendations for treatment of mechanical prosthetic heart valve thrombosis (PVT) include systemic thrombolysis and/or reoperation. Data on complications and outcome are limited. Methods: Clinical and echocardiographic findings of 17 patients with mechanical PVT tr-ere reviewed. Complications and outcome of surgery and/or thrombolysis were analysed. Prospective follow-up was obtained. Results: Symptomatic PVT occurred 8.4 +/- 7.2 years after mechanical valvereplacement at mean age 55 +/- 15 years. Thrombosis involved the mitral valve in 12 patients (71%), the aortic valve in 4 (24%) and the tricuspid valve in one (6%). The reason for PVT was inadequate anticoagulation in ii patients (65%), endomyocardial fibrosis in 2 (12%) and unknown in 4 (24%). Prior to diagnosis, systemic emboli occurred in 6 patients (35%). Thirteen patients (76%) presented in functional class NYHAIV. Haemodynamic valve obstruction nas documented by echocardiography in 15 patients (88%). Treatment included primary reoperation in 12 patients (71%), thrombolysis with urokinase in 3 (18%) (with reoperation in 1), reinstitution of adequate anticoagulation in one (6%); death occurred before treatment in one (6%), Intraoperatively both pannus and thrombus were found in 5 of lj patients (38%). Treatment-related emboli occurred in 5 patients (29%), to the brain in 3, to the legs in one and to a coronary artery in one. Fire patients died (mortality 29%) within 30 days due to multiorgan failure/septicaemia (3 patients), congestive heart failure (1), or cerebral emboli (1). Follow-up after 28 +/- 28months in the 12 surviving patients was unremarkable. Conclusions: The most common aetiology for obstructive PVT is thrombus formation due to inadequate anticoagulation. PVT remains a serious complication with high morbidity and mortality despite aggressive treatment by thrombolysis and/or surgery Surgery is often needed due to the frequent presence of pannus and/or large thrombi. However, long-term prognosis after successful treatment of PVT is excellent.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 18:34:33