Abstract
Twenty patients underwent nonsurgical and/or surgical treatment for obstruction of mechanical prosthetic valves. The obstructed prosthetic valve was in the aortic position in 11 patients, in the mitral position in 5, and in the tricuspid position in 4. Twelve patients had a bileaflet valve (3 aortic, 5 mitral, 4 tricuspid), and 8 had a tilting disk valve (all aortic). The diagnosis of prosthetic valve obstruction was made by cineradiography and echocardiography. Thrombolytic therapy was instituted in a series of our 10 most recent patients (11 cases), except for one patient with acute renal failure, regardless of the position of the obstructed prosthetic valve. Successful thrombolysis was achieved in 6 cases (54.5%). Six patients required surgical treatment subsequent to either failed or incomplete thrombolysis, and one patient died of congestive heart failure 1 month after surgery. Nonfatal neurologic events occurred in 2 cases (18.2%). A total of 16 patients underwent surgical treatment. Two (12.6%) of the 16 patients died of causes unrelated to the operative procedures before discharge from the hospital. These results suggest that thrombolytic therapy appears to be an attractive nonsurgical alternative for valve thrombosis when the patient's clinical condition is not critical, and thus surgical treatment should only be performed in an emergency on seriously ill patients.
Similar content being viewed by others
References
Björk VO, Henze A (1979) Ten years' experience with the Björk-Shiley tilting valve. J Thorac Cardiovasc Surg 78:331–342
Horstkotte D, Korfer R, Seipel L, Bricks W, Loogen F (1983) Late complications in patients with Björk-Shiley and St. Jude Medical heart valve replacement. Circulation 68 [Suppl II]:II175-II184
Moreno-Cabral RJ, McNamara JJ, Mamiya RT, Brainard SC, Chung GKT (1978) Acute thrombotic obstruction with Björk-Shiley valves. Diagnostic and surgical considerations. J Thorac Cardiovasc Surg 75:321–329
Thorburn CW, Morgan JJ, Shanahan MX, Chang VP (1983) Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis. Am J Cardiol 51:1128–1132
Peterffy A, Henze A, Savidge GF, Landou C, Björk VO (1980) Late thrombotic malfunction of the Björk-Shiley tilting disc valve in the tricuspid position: principles for recognition and management. Scand J Thorac Cardiovasc Surg 14:33–41
Martinell J, Jiménez A, Rábago G, Artiz V, Fraile J, Farré J (1991) Mechanical cardiac valve thrombosis. Is thrombectomy justified? Circulation 84 [Suppl III]:II170-II175
Montero CG, Mula N, Brugos R, Pradas R, Figuera D (1989) Thrombectomy of the Björk-Shiley prosthetic valve revised: Long-term results. Ann Thorac Surg 48:824–828
Roudaut R, Labbe T, Lorient-Roudaut FM, Gosse P, Baudet E, Fontan F, Besse P, Dallocchio M (1992) Mechanical cardiac valve thrombosis. Is fibrinolysis justified? Circulation 86 [Suppl II]:II8-II15
Aoyagi S, Fukunaga S, Oryoji A, Kosuga K, Oishi K (1995) Malfunction of the St. Jude Medical valve: Cineradiographic and Doppler echocardiographic evaluation. Jinko Zoki (Jpn J Artif Organs) 24:405–408
Ledain LD, Ohayon JP, Colle JP, Lorient-Roudaut FM, Roudaut R, Besse PM (1986) Acute thrombotic obstruction with disc valve prostheses: Diagnostic considerations and fibrinolytic treatment. J Am Coll Cardiol 7:743–751
Ayuso LA, Juffe A, Rufilanchas JJ, Babin F, Burgos R, Figuera D (1982) Thrombectomy: Surgical treatment of the thrombosed Björk-Shiley prosthesis. J Thorac Cardiovasc Surg 84:906–910
Aoyagi S, Nishi Y, Hirano A, Tanaka K, Yanagi I, Yanai T, Kosuga K, Oishi K (1989) Cineradiographical significance for diagnosis and treatment of thrombosed Björk-Shiley prosthesis in the aortic position (in Japanese with English abstract). Jinko Zoki (Jpn J Artif Organs) 18:753–756
Aoyagi S, Higa Y, Matsuzoe S, Nishi Y, Tanaka K, Kawara T, Oryoji A, Kosuga K, Oishi K (1993) Obstruction of the St. Jude Medical valve: Diagnostic and therapeutic values of cineradiography. Thorac Cardiovasc Surgeon 41:357–363
Reisner SA, Meltzer RS (1988) Normal values of prosthetic valve Doppler echocardiographic parameters: A review. J Am Soc Echo 1:201–210
Panidis IP, Ross J, Mintz GS (1986) Normal and abnormal prosthetic valve function as assessed by Doppler echocardiography. J Am Coll Cardiol 8:317–326
Aoyagi S, Nishi Y, Kawara T, Oryoji A, Kosuga K, Ohishi K (1993) Doppler echocardiographic evaluation of St. Jude Medical valves in the tricuspid position. J Heart Valve Dis 2:279–286
Silber H, Khan SS, Matloff JM, Chaux A, DeRobertis M, Gray R (1993) The St. Jude valve: Thrombolysis as the first line of therapy for cardiac valve thrombosis. Circulation 87:30–37
Ben-Zvi J, Hildner FJ, Chandraratna PA, Samet P (1974) Thrombosis on Björk-Shiley aortic valve prosthesis (7 cases). Am J Cardiol 34:538–544
Venugopal P, Kaul U, Iyer KS, Rao IM, Balram A, Das B, Sampathkumar A, Mukherjee S, Rajani M, Wasir HS, Bhatia ML, Raghavan V, Reddy KS, Gopinath N (1986) Fate of thrombectomized Björk-Shiley valves: A long-term cinefluoroscopic, echocardiographic, and hemodynamic evaluation. J Thorac Cardiovasc Surg 91:168–173
Kontos GJ, Schaff HV, Orszulak TA, Puga FJ, Pluth JR, Danielson GK (1989) Thrombotic obstruction of disc valves: Clinical recognition and surgical management. Ann Thorac Surg 48:60–65
Deveri E, Sareli P, Wisenbaugh T, Cronje SL (1991) Obstruction of mechanical heart valve prostheses: Clinical aspects and surgical management. J Am Coll Cardiol 17:646–650
Luluga IT, Carrera D, D'Oliveira J, Cantaluppi CG, Santin H, Molteni L (1971) Successful thrombolytic therapy after acute tricuspid valve obstruction. [Letter] Lancet 1:1067–1068
Kurzrok S, Singh AK, Most AS, Williams DO (1987) Thrombolytic therapy for prosthetic cardiac valve thrombosis. J Am Coll Cardiol 9:592–598
Graver LM, Gelber PM, Tyras DH (1988) The risks and benefits of thrombolytic therapy in acute aortic and mitral prosthetic valve dysfunction: Report of a case and review of the literature. Ann Thorac Surg 46:85–88
Vitale N, Renzulli A, Cerasuolo F, Caruso A, Festa M, de Luca L, Cotrufo M (1994) Prosthetic valve obstruction: Thrombolysis versus operation. Ann Thorac Surg 57:365–370
Karagoz HY, Babacan KM, Zorlutuna YI, Tasdemir O, Yakut C, Bayazit K (1989) In vitro thrombolysis of thrombosed valve prostheses: therapeutic considerations of left-sided thrombotic lesions. Eur J Cardiothorac Surg 3:87–88
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aoyagi, S., Fukunaga, S., Suzuki, S. et al. Obstruction of mechanical valve prostheses: Clinical diagnosis and surgical or nonsurgical treatment. Surg Today 26, 400–406 (1996). https://doi.org/10.1007/BF00311926
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00311926