title: Prosthetic Valve Thrombosis: Diagnosis and Management.
abstract: St. Jude mechanical prosthesis is the most commonly used prosthetic device with least valvular complications with excellent hemodynamics. However, prosthetic valve thrombosis is one of the serious complications, with rates between 0.03% and 0.13% per patient-year depending on the type of anticoagulation used and compliance to the therapy. Transthoracic echocardiography (TTE) is the initial screening tool (class I) that would provide clues for the assessment of valvular hemodynamics. Fluoroscopy is an alternate imaging modality for the assessment of mechanical leaflet motion, especially in patients when prosthetic valves are difficult to image on TTE or transesophageal echocardiography. A complete fluoroscopic evaluation of a prosthetic valve includes assessment of valvular motion and structural integrity. Opening and closing angles can be measured fluoroscopically to determine whether a specific valve is functioning properly. We discuss a case of a 91-year-old man with thrombosis of bileaflet mechanical mitral prosthesis that was demonstrated on real-time fluoroscopy (not evident on TTE). An algorithmic approach to diagnosis and management of prosthetic heart valve thrombosis is outlined.
authors.affiliation: 1Department of Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY; and 2Department of Pathology, Westchester Medical College, New York Medical College, Valhalla, NY.
authors.forename: Jalaj
authors.initials: J
authors.lastname: Garg
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Sowmya
authors.initials: S
authors.lastname: Pinnamaneni
authors.forename: Judy
authors.initials: J
authors.lastname: Sarungbam
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005471:Fluoroscopy; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D013927:Thrombosis / Q000175:diagnosis* / Q000628:therapy*