Late dysfunction of a mechanical aortic valve after long-term low molecular weight heparin therapy: a case report
Ontology highlight
ABSTRACT:
SUBMITTER:
PROVIDER: S-EPMC11337000 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:A 31-year-old pregnant woman with a mechanical aortic valve developed a thrombus on her mechanical aortic valve due to subtherapeutic low molecular weight heparin dosage. She received intravenous heparin followed by warfarin. low molecular weight heparin dosing in pregnancy should be individualized, considering weight, physiological changes, and adjusted based on levels.
| S-EPMC10715988 | biostudies-literature
Project description:BackgroundIntermittent stuck valve after mechanical valve replacement surgery is a very rare and severe complication.Case summaryWe present 1 case of a 53-year-old woman after aortic valve replacement for severe aortic valve stenosis combined with hypertrophy septum. She was diagnosed with intermittent stuck valve only 1 day after surgery by clinical symptoms, intraoperative transoesophageal echocardiogram, and intraoperative findings.ConclusionsAlthough indications for concomitant myectomy during aortic valve replacement are not clear, we recommend myectomy to prevent stuck valve after St Jude Medical Regent prosthesis replacement for severe aortic valve stenosis combined with hypertrophy septum.
| S-EPMC5340450 | biostudies-literature
Project description: Not available
| S-EPMC3189308 | biostudies-literature
Project description:Mechanical heart valves require long-term anticoagulation strategies to prevent valve thrombosis. Pregnant women with mechanical heart valves are especially susceptible to valve thrombosis, given their procoagulant state and the complexity of anticoagulation strategies during pregnancy. We describe a case of prosthetic valve thrombosis in a pregnant woman treated successfully with low-dose slow infusion of thrombolytic therapy. A 23-year-old pregnant woman with a mechanical aortic valve on subcutaneous enoxaparin presented to the maternal cardiac clinic for a follow-up visit. Her physical exam was notable for a loud grade three crescendo decrescendo murmur and follow-up transthoracic echocardiography revealed peak and mean gradients of 87 and 58 mmHg, respectively. The Doppler velocity index (DVI) was 0.24 with an acceleration time of 130 ms. Fluoroscopy confirmed a stuck leaflet disk. Thrombolysis was performed using a low-dose ultra-slow infusion of thrombolytic therapy (1 mg/h of tissue-type plasminogen activator) with the restoration of normal valve function after 8 days. A repeat transthoracic echocardiography showed a decrease in the peak and mean gradients to 37 and 21 mmHg, respectively, with an improvement in the DVI to 0.53. Repeat fluoroscopy confirmed the opening of both leaflet disks. Treatment options for mechanical aortic valve thrombosis are either slow-infusion, low-dose thrombolytic therapy or emergency surgery. The hypercoagulable state of pregnancy makes adequate anticoagulation, proper monitoring, and medication adherence even more critical to prevent valve thrombosis. Physicians should educate pregnant patients on anticoagulation strategies and participate in shared decision-making.
| S-EPMC9757675 | biostudies-literature
Project description:BackgroundTranscatheter valve replacement is a less invasive alternative to surgical valve replacement and has become increasingly popular. It is often the preferred approach for patients with high surgical risk. In patients with multiple prior sternotomies and multi-valvular failure, sequential transcatheter valve replacements may be a viable option.Case summaryWe present the case of a 61-year-old-man with two prior sternotomies who underwent sequential transcatheter replacements of the aortic and pulmonic valves for symptomatic aortic and pulmonary stenosis. He was deemed high risk for a repeat sternotomy. The decision to perform sequential transcatheter aortic valve replacement (TAVR) and transcatheter pulmonic valve replacement (TPVR) a month apart was made. Patient underwent valve-in-valve TAVR in a stentless bioprosthetic valve with 29-mm Edwards Sapien 3 followed by TPVR with 26-mm Edwards Sapien 3. He tolerated both procedures well and was asymptomatic at 1-month follow up.DiscussionTo our knowledge, this is the first reported successful case of sequential TAVR and TPVR with right ventricular outflow tract stenting in a patient with both aortic and pulmonic bioprosthetic valve dysfunction. Our case demonstrates that transcatheter approach to multi-valvular replacements may be a viable option for high-risk surgical patients.
| S-EPMC10117369 | biostudies-literature
Project description:Venereal syphilis, caused by Treponema pallidum, is a major global health problem. Untreated latent syphilis can progress to tertiary syphilis, often leading to severe complications such as cardiac involvement, particularly syphilitic aortitis, which may manifest decades after the initial infection. We present a case of a 46-year-old woman who developed an ascending aortic aneurysm and severe aortic valve insufficiency due to late-stage syphilis. She presented with bilateral lower limb edema, intermittent chest pain, decreased functional capacity, and dyspnea, ultimately requiring hospitalization for cardiogenic shock. Diagnostic imaging revealed significant aortic valve damage and aneurysmal dilation of the ascending aorta, while serological tests confirmed tertiary cardiovascular syphilis. Surgical intervention involved the reconstruction of the ascending aorta and replacement of the aortic valve with a bioprosthetic valve. Histopathological analysis indicated chronic endocarditis. Postoperative management included intensive care support and antibiotic treatment. The patient demonstrated satisfactory recovery, with no further complications reported at the 3-month follow-up.
| S-EPMC11662311 | biostudies-literature
Project description:BackgroundThe ideal aortic valve replacement strategy in young- and middle-aged adults remains up for debate. Clinical practice guidelines recommend mechanical prostheses for most patients less than 50 years of age undergoing aortic valve replacement. However, risks of major hemorrhage and thromboembolism associated with long-term anticoagulation may make the pulmonary autograft technique, or Ross procedure, a preferred approach in select patients.MethodsData were retrospectively collected for patients 18-50 years of age who underwent either the Ross procedure or mechanical aortic valve replacement (mAVR) between January 2000 and December 2016 at a single institution. Propensity score matching was performed and yielded 32 well-matched pairs from a total of 216 eligible patients.ResultsDemographic and preoperative characteristics were similar between the two groups. Median follow-up was 7.3 and 6.9 years for Ross and mAVR, respectively. There were no early mortalities in either group and no statistically significant differences were observed with respect to perioperative outcomes or complications. Major hemorrhage and stroke events were significantly more frequent in the mAVR population (p < .01). Overall survival (p = .93), freedom from reintervention and valve dysfunction free survival (p = .91) were equivalent.ConclusionsIn this mid-term propensity score-matched analysis, the Ross procedure offers similar perioperative outcomes, freedom from reintervention or valve dysfunction as well as overall survival compared to traditional mAVR but without the morbidity associated with long-term anticoagulation. At specialized centers with sufficient expertize, the Ross procedure should be strongly considered in select patients requiring aortic valve replacement.
| S-EPMC9542516 | biostudies-literature
Project description:BackgroundStudies performed to date reporting outcomes after mechanical or bioprosthetic aortic valve replacement (AVR) have largely neglected the young female population. This study compares long-term outcomes in female patients aged < 50 years undergoing AVR with either a mechanical or bioprosthetic valve.MethodsIn this propensity-matched study, we compared outcomes after mechanical AVR (n = 57) and bioprosthetic AVR (n = 57) between 2004 and 2018. The primary outcome of this study is survival. Secondary outcomes include the rate of reoperation, stroke, myocardial infarction, rehospitalization for heart failure, and incidence of serious adverse events. Outcomes were measured over 15 years, with a median follow-up of 7.8 years.ResultsIn patients receiving a mechanical AVR vs a bioprosthetic AVR, overall survival at median follow-up was equivalent, at 93%. There is a lower rate of reoperation in patients receiving a mechanical AVR vs a bioprosthetic AVR (1.8% vs 8.8%). The rate of new-onset atrial fibrillation was significantly higher in the mechanical AVR group vs the bioprosthetic AVR group (18.2% vs 7.3%). No significant difference was seen in the rate of serious adverse events.ConclusionsThese results provide contemporary data demonstrating equivalent long-term survival between mechanical and bioprosthetic AVR, with higher rates of new atrial fibrillation after mechanical AVR, and higher rates of reoperation after bioprosthetic AVR. These results suggest that either valve type is safe, and that preoperative assessment and counselling, as well as the follow-up, medical treatment and indications for intervention, must be a collaborative decision-making process between the clinician and the patient.
| S-EPMC7711020 | biostudies-literature
Project description:Late balloon valvuloplasty can be used to treat under-expansion-related transcatheter heart valve (THV) dysfunction. Whether this can be performed following redo-THV implantation is unknown. Herein, we report a case of a 72-year-old male presenting with symptomatic gradient elevation following redo mitral valve-in-valve implantation. The patient was successfully treated with late balloon valvuloplasty with gradient improvement. In conclusion, late valvuloplasty is effective even with several layers of valves. However, larger studies are required to clarify the role of this approach further.
| S-EPMC10644176 | biostudies-literature
Project description:BackgroundPeriprocedural antithrombotic prophylaxis in patients undergoing surgical valve procedures (SVP) is insufficiently investigated. Low molecular weight heparin (LMWH) has been considered as an alternative to unfractionated heparin (UFH). However, safety and efficacy of this prophylaxis strategy is unknown. This study aimed to investigate safety and efficacy of periprocedural LMWH prophylaxis and determine optimal dosage and timing for periprocedural cessation and initiation.MethodsThe present study is a retrospective, single-center observational analysis of 388 patients who underwent SVP (valve replacement or valvuloplasty) between 2015 and 2016. In-hospital endpoints were bleeding, transfusions, reoperation due to bleeding, and thromboembolic events.ResultsGiving the first dose of LMWH on the day of SVP was a risk factor for bleeding (OR 1.07; 95% CI 1.04-1.10; p < 0.001), transfusions (OR 1.04; 95% CI 1.01-1.07; p = 0.008) and reoperation due to bleeding (OR 1.20; 95% CI 1.12-1.28; p < 0.001), with > 40 mg/day as a predictor. A higher dosage of LMWH premedication was an independent risk factor for bleeding (OR 1.02; 95% CI 1.00-1.04; p = 0.03) and transfusion (OR 1.03; 95% CI 1.01-1.05; p = 0.01), with > 60 mg/day as a predictor for these events. LMWH dosed within 24 h prior to SVP increased the risk of transfusion (AUC 0.636; 95% CI 0.496-0.762; p = 0.04).ConclusionsBleeding is an important early concern after surgical valve procedures. Safety and efficacy of periprocedural prophylaxis with LMWH depends on dosage and the timing of its administration. The most optimal periprocedural prophylaxis in the SVP population appears to be LMWH in dosage of 40-60 mg/day, which is recommended for deep vein thrombosis prophylaxis, ceased at least one day before SVP.
| S-EPMC8078967 | biostudies-literature