Symptomatic mechanical heart valve thrombosis: high morbidity and mortality despite successful treatment options

Background: Recommendations for treatment of mechanical prosthetic heart va lve thrombosis (PVT) include systemic thrombolysis and/or reoperation. Data on complications and outcome are limited. Methods: Clinical and echocardiographic findings of 17 patients with mechan ical PVT tr-ere reviewed. Complications and outcome of surgery and/or throm bolysis were analysed. Prospective follow-up was obtained. Results: Symptomatic PVT occurred 8.4 +/- 7.2 years after mechanical valve replacement at mean age 55 +/- 15 years. Thrombosis involved the mitral val ve in 12 patients (71%), the aortic valve in 4 (24%) and the tricuspid valv e in one (6%). The reason for PVT was inadequate anticoagulation in ii pati ents (65%), endomyocardial fibrosis in 2 (12%) and unknown in 4 (24%). Prio r to diagnosis, systemic emboli occurred in 6 patients (35%). Thirteen pati ents (76%) presented in functional class NYHAIV. Haemodynamic valve obstruc tion nas documented by echocardiography in 15 patients (88%). Treatment inc luded primary reoperation in 12 patients (71%), thrombolysis with urokinase in 3 (18%) (with reoperation in 1), reinstitution of adequate anticoagulat ion in one (6%); death occurred before treatment in one (6%), Intraoperativ ely both pannus and thrombus were found in 5 of lj patients (38%). Treatmen t-related emboli occurred in 5 patients (29%), to the brain in 3, to the le gs in one and to a coronary artery in one. Fire patients died (mortality 29 %) within 30 days due to multiorgan failure/septicaemia (3 patients), conge stive heart failure (1), or cerebral emboli (1). Follow-up after 28 +/- 28 months in the 12 surviving patients was unremarkable. Conclusions: The most common aetiology for obstructive PVT is thrombus form ation due to inadequate anticoagulation. PVT remains a serious complication with high morbidity and mortality despite aggressive treatment by thrombol ysis and/or surgery Surgery is often needed due to the frequent presence of pannus and/or large thrombi. However, long-term prognosis after successful treatment of PVT is excellent.