title: Sources of thromboembolism in patients with correctly functioning mechanical valves: a single-center transesophageal echocardiographic study.
abstract: BACKGROUND
  In patients with mechanical prostheses (MP), thromboembolism is one of the most serious complications. The study aim was to assess the incidence of sources of thromboembolism in patients with correctly functioning MP with and without a history of thromboembolism.
  
  
  METHODS
  Two hundred ninety-seven patients with correctly functioning MP were enrolled in this single-center, transesophageal echocardiographic (TEE), retrospective, observational study. Two groups were analyzed: Group A, 183 patients with a history of thromboembolism, and Group B, 114 patients with no history of thromboembolism.
  
  
  RESULTS
  Definite sources of thromboembolism were revealed in 59% of patients in Group A, and sources of potential thromboembolism were revealed in 13% of patients in Group B (P < .001). Multiple sources of thromboembolism were present in 9% of patients in Group A and 1% of patients in Group B. Localization of sources of thromboembolism included MP ring (59% and 53% of patients in Groups A and B, respectively); left atrium/left atrium appendage (24%/21% and 13%/40% of patients in Groups A and B, respectively); and aorta (12% and 13% of patients in Groups A and B, respectively). Patients with multiple sources of thromboembolism were older (P < .001) and in a higher New York Heart Association (NYHA) class (P = .004). Patients with sources of thromboembolism in the aorta were older than the rest of the group (P < .01).
  
  
  CONCLUSIONS
  In patients with correctly functioning MP, sources of thromboembolism are observed 4 times more often in case of the positive history of thromboembolism. The most common source of thromboembolism is thrombosis of MP ring. Age and heart failure predispose multiple sources of thromboembolism. One might consider control TEE after mechanical valve implantation, but only in selected group of patients without embolic events but with a higher risk of thromboembolism.
authors.affiliation: Clinic of Cardiology, Institute of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Maciejewski
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Piestrzeniewicz
authors.forename: Ryszard
authors.initials: R
authors.lastname: Jaszewski
authors.forename: Agata
authors.initials: A
authors.lastname: Bielecka-Dabrowa
authors.forename: Jan H
authors.initials: JH
authors.lastname: Goch
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*