title: Are prosthetic heart valve fibrin strands negligible? The associations and significance.
abstract: BACKGROUND
  Filamentous fibrin strands (FSs) attached to valve prostheses have been well described in patients undergoing transesophageal echocardiography, but the frequency and clinical significance of these strands remain poorly defined. The aims of this study were to determine the frequency of prosthetic valve strands and to assess their significance in relation to clinical cerebral ischemic events (CIEs) and anticoagulant status.
  
  
  METHODS
  Three hundred consecutive patients with 421 prosthetic heart valves were evaluated for the presence of FSs (highly mobile, filamentous masses<1 mm thick).
  
  
  RESULTS
  FSs were found in 139 patients (49%) and 147 prostheses (38%) in patients with left-sided prostheses, with a significant association between FSs, CIEs, and anticoagulant status (P<.001). A lower international normalized ratio (<2.5) had a positive association with the occurrence of CIEs.
  
  
  CONCLUSIONS
  There is a significant association between FSs, CIEs, and patient's anticoagulant status; therefore, aggressive anticoagulation and close follow-up are recommended for these patients.
authors.affiliation: Department of Cardiovascular Medicine, Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Kiavar
authors.forename: Anita
authors.initials: A
authors.lastname: Sadeghpour
authors.forename: Hooman
authors.initials: H
authors.lastname: Bakhshandeh
authors.forename: Parisa
authors.initials: P
authors.lastname: Tayyebi
authors.forename: Hossein Ali
authors.initials: HA
authors.lastname: Bassiri
authors.forename: Maryam
authors.initials: M
authors.lastname: Esmaeilzadeh
authors.forename: Majid
authors.initials: M
authors.lastname: Maleki
authors.forename: Feridoun
authors.initials: F
authors.lastname: Noohi
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D005337:Fibrin / Q000032:analysis; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D005337:Fibrin