MECHANICAL CARDIAC-VALVE THROMBOSIS IN PATIENTS IN CRITICAL HEMODYNAMIC COMPROMISE

Background: Valve obstruction is a life threatening complication of me chanical valve prosthesis. Methods: From 1985 to 1993, 29 consecutive patients were hospitalized in our intensive care unit for mechanical p rosthetic valve thrombosis (PVT). There were 12 men and 17 women aged 25-75 years (57 +/- 12). Prosthetic valve location was mitral in 14 pa tients, aortic in 6, aortic and mitral in 9. PVT occurred from 15 days to 174 months (67 +/- 52 months) after surgery. Delay from first symp toms to hospitalization ranged from 1 to 45 days (11 +/- 11). Results: First clinical symptoms were progressive left heart failure in 17 pat ients, stroke in 6, and chest pain in 6. Furthermore, acute myocardial infarction Tvas later documented in 3. Left heart failure NYHA III-IV was present in 26 patients (90%) on admission and 10 of those were in cardiogenic shock. Anticoagulation regimen was inadequate In 13 cases (45%). It has been recently stopped in 8 patients and incorrectly con ducted in 5. Total hospital mortality was 41.3% (12). It was independe nt of type and position of the valve prosthesis. Diagnosis of PVT was only made at autopsy in 3 patients who died of recurrent myocardial in farction (2) or cardiogenic shock (1), Five further patients died befo re any surgery could be attempted (cardiac arrest: 2, cardiogenic shoc k: 3). Valve replacement could be done in 21 cases, 7 of whom were in cardiogenic shock and 9 had severe pulmonary edema, Four patients died after surgery, the operative mortality was 19%. Conclusion: PVT remai ns a serious complication of mechanical heart valve prostheses. Overal l mortality rate is high, related to difficulty to diagnosis, delay to hospitalization and, severe clinical condition al admission. In our s tudy, operative risk remained acceptable even when the clinical presen tation was severe. (C) 1997 Elsevier Science B.V.