Study Of Clinical Characteristics and Risk Determinants Of Patients With Prosthetic Valve Thrombosis: A Tertiary Care Hospital-Based Observational Study Volume 3 - Issue 4

Vaishali Verma, Sanjeev Asotra*, Rajesh Sharma, PC Negi, Arvind Kandoria, Neeraj Ganju, Rajeev Marwaha, Shivani Rao, Kunal Mahajan and Ashu Gupta

• Department of Cardiology, I.G.M.C Shimla, India

Received:June 8, 2020;   Published:June 21, 2021

Corresponding author: Sanjeev Asotra, Department of Cardiology, I.G.M.C Shimla, India

DOI: 10.32474/ACR.2021.03.000170

 

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Abstract

Introduction: Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The present study aims to evaluate patients with prosthetic valve thrombosis in terms of the clinical characteristics, risk determinants, treatment, and outcomes in the prospective observational study.

Material and Methods: The observational study was conducted in a tertiary care center. All patients suspected of having prosthetic valve dysfunction underwent clinical, echocardiography, and fluoroscopic examination. Data regarding risk determinants, clinical characteristics, and response to treatment was categorized on the basis of serial echocardiography and fluoroscopy into 3 classes; complete response, partial response, and failed treatment.

Result: Out of 29 patients 17 (59%) were females and 12 (41%) were males. The mean age was 46.6years with an age range from 20-80 years. 15 (52%) patients were post MVR, 9 (32%), post DVR and 5 (17%) were post AVR. Dyspnoea was the presenting complaint in all the patients presenting with valve thrombosis. Mitral valve thrombosis was seen in 19 (65%), aortic valve thrombosis in 8 (28%), and tricuspid valve thrombosis in 2 (7%). 86% of patients had sub-therapeutic INR. Intensification of anticoagulation and thrombolytic therapy was the treatment modalities deployed.76% of patients received thrombolytic therapy and streptokinase was the most common agent used in 82% of patients. Majority of patients presented with symptoms of NYHA class III. 62% of patients showed complete response, 24% of patients showed partial response, and 4 (14%) had no response to lytic therapy. 7 out of 29 patients landed up in complications. 4 out of 29 patients had minor bleeds in the form of oral mucosal ooze and haematuria. 3 patients succumbed to complications, one of whom had a major bleed in the form of intracranial hemorrhage and two had worsening of heart failure.

Conclusion: The most important risk factor attributed to the occurrence of prosthetic valve thrombosis was non-compliance to treatment leading to subtherapeutic INR. Mitral valve thrombosis was most commonly seen and Fibrinolysis can be considered as effective therapy even in patients presenting with NYHA Class III/IV especially in resource-stricken developing countries.

Keywords:Prosthetic Valve Thrombosis; PVT; Clinical Characteristics; Risk Determinants; Sub-optimal Anticoagulation; Cinefluoroscopy

Abstract| Introduction| Material and Methods| Response to Treatment| Various Treatment Regimes for Thrombolytic Agents:| Response to Treatment :| Non-Compliance To Treatment| Statistical Analysis| Results| Discussion| Study Limitations| Conflicts Of Interest| Ethical Approval| References|