Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week.

Autor:	Soria Jiménez CE; Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA., Papolos AI; Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA., Kenigsberg BB; Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA., Ben-Dor I; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA., Satler LF; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA., Waksman R; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA., Cohen JE; Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA., Rogers T; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA. Electronic address: toby.rogers@medstar.net.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 May 30; Vol. 81 (21), pp. 2115-2127.
DOI:	10.1016/j.jacc.2023.03.412
Abstrakt:	Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomography, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Transcatheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation. Competing Interests: Funding Support and Author Disclosures Dr Waksman has served on advisory boards of Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, and Pi-Cardia Ltd; has been a consultant for Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd, Swiss Interventional Systems/SIS Medical AG, Transmural Systems, and Venous MedTech; has received institutional grant support from Amgen, Biotronik, Boston Scientific, Chiesi, Medtronic, and Philips IGT; and is an investor in MedAlliance and Transmural Systems. Dr Rogers has been a consultant and physician proctor for Medtronic, Edwards Lifesciences, and Boston Scientific; has served on advisory boards of Medtronic and Boston Scientific; and holds equity interest in Transmural Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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