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Thrombosis of a Mechanical Mitral Valve Prosthesis

  • Gilberto Loiola De Vasconcelos
  • Saulo Victor Benevides Nunes
  • Joaquim David Carneiro Neto
  • Camila Lopes do Amaral
Chapter

Abstract

Patient A.N.S.H., 43 years old, female, married, brown, born and raised in the North-CE region, with a medical history of hypertension, rheumatic fever, and a mechanical mitral valve prosthesis for 7 years, with continuous oral anticoagulation therapy since the prosthesis, has been asymptomatic during the clinical follow-up.

However, she noticed that she recently started to present hypermenorrhea, looking for her gynecologist, from whom she was diagnosed with uterine myoma, with a hysterectomy indication. Shortly after, she was admitted in the local hospital for the gynecological surgery, when she was advised to discontinue oral anticoagulation, evolving on the 4th day with a severe cardiac insufficiency (NYHA IV), requiring cardiologic emergency assistance.

Her exams have shown anemia, acute renal injury, and alterations of coagulation panel. Due to her critical state, she was sent to ICU, where she initiated the appropriate therapy and performed a colorful Doppler echocardiography, which indicated the presence of a metallic prosthesis in the mitral position with significant dysfunction. In addition, it showed a greatly reduced mobility of their brochures, suggesting a thrombosis of the prosthesis.

Within an urgency character, the patient was sent to the surgical center, where, after other preoperative exams were done, she had her thrombosed mechanical prosthesis replaced with success for a bioprosthesis, about 17 h after her arrival at the Cardiology Hospital.

Bibliography

  1. 1.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119(7):1034–48.CrossRefGoogle Scholar
  2. 2.
    Baron TH, Kamath PS, McBane RD. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med. 2013;368:2113–24.CrossRefGoogle Scholar
  3. 3.
    Katz M, Tarasoutchi F, Grinberg M. Thrombolytic therapy in prosthetic valve thrombosis. In: Arquivos Brasileiros de Cardiologia, vol. 85. 1st ed; 2005. p. 76–8.Google Scholar
  4. 4.
    Roudat R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93:137–42.CrossRefGoogle Scholar
  5. 5.
    Cáceres-Loriga FM, Perez-Lopez H, Santos-Garcia J, Morlans-Hernandez K. Prosthetic heart valve thrombosis: pathogenesis diagnosis and management. Int J Cardiol. 2006;110:1–6.CrossRefGoogle Scholar
  6. 6.
    Garcez JDS, Rosa VEE, Lopes ASSA, Accorsi TAD, Fernandes JRC, Pomerantzeff PM, Avila WS, Tarasoutchi F. Patient management with metallic valve prosthesis during pregnancy and postpartum period. Arq Bras Cardiol. 2015;105:426–9.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Lengyel M, Fuster V, Keltai M, Roudaut R, Schulte HD, Seward JB, Chesebro JH, Turpie AGG. Guidelines for management of left-sided prosthetic valve thrombosis: a role for thrombolytic therapy. J Am Coll Cardiol. 1997;30:1521–6.CrossRefGoogle Scholar
  8. 8.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary. J Am Coll Cardiol. 2014;63:2438–88.CrossRefGoogle Scholar
  9. 9.
    Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL, Angelini A, Antunes M, Fernandez MAG, Gohlke-Baerwolf C, Habib G, McMurray J, Otto C, Pierard L, Pomar JL, Prendergast B, Rosenhek R, Uva MS, Tamargo J. Guidelines on the management of valvular heart disease. Eur Heart J. 2007;28(2):230–68.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gilberto Loiola De Vasconcelos
    • 1
  • Saulo Victor Benevides Nunes
    • 1
  • Joaquim David Carneiro Neto
    • 1
  • Camila Lopes do Amaral
    • 1
  1. 1.Federal University of Ceará (UFC)SobralBrazil

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