الفهرس 
Assessment of Prosthetic Mitral ValvesOnly 14 pages are availabe for public view
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Abstract
Reddy et al, 1994)
Operation with either valve replacement or thrombectomy with debridment was
considered the treatment of choice for acute PVT, however operation in this situation
is most demanding technically, often performed under urgent circumstances regardless
of all the re-operation-related risks with operative mortality of 19.6% for repeat mitral
valve replacement. Surgical valve debridement is occasionally sufficient and may be
associated with a lower operative mortality (Montero 1989), although the rate of
rethrombosis may be significantly higher. (Matenill, 1991).
Re-operations are technically more difficult than primary operations because of
adhesions around the heart and the common association of pulmonary hypertension
with valve dysfunction. Also, replacement operations are often performed in
functionally compromised patients who tolerate complications poorly or have little
reserve. In the past, redo valve surgery has been associated with a considerably higher
operative mortality than primary valve surgery, particularly in patients who have had
multiple prior replacements. However, in the modern era there has been some
improvement in both morbidity and mortality. O’Kane et al 2001.
Patients in NYHA functional class III and IV had a mortality risk up to 41%
(Alveraz-Ayuso et al, 1982) and that for emergency procedures was 37% to 55%
.(Deviri et al, 1991)
Thrombolytic therapy has been tried in cases with acute prosthetic Mitral valve
thrombosis as an alternative to emergency operation. (Witchitz et al, 1980; Ledain et
al, 1983; and Roudaut et al, 1992)
Although thrombolytic therapy has been accepted for routine treatment of
tricuspid valve prosthetic occlusions where Luluaga et al (Luluaga et al, 1971) first
reported successful treatment of thrombosed Starr-Edward prosthesis in the tricuspid
position with thrombolytic therapy in 1971, the concern for potential risk of systemic
embolization has limited its use in left sided prosthetic valve thrombotic occlusion.
(Ledain et al, 1983; and Roudaut et al, 1992)
The current study is from Jan 2005 to October 2006, conducted on 40 patients
with acute prosthetic Mitral valve(s) occlusions with suspected thrombosis admitted to
intensive care unite in National Heart Institute and Ain-Shams university hospital.
Patients treated either by thrombolytic therapy or surgical re-replacement with
close follow up for 6 & 12months, aiming at studying the feasibility of thrombolytic
therapy as a suitable alternative to operation in patients presented with acute prosthetic
mitral valve occlusion, in term of success, failure and complication rate.
So thrombolytic therapy was considered for patients fulfilling the criteria of
acute prosthetic mitral valve thrombosis with no contraindication for thrombolytic
therapy (group A), and compared to surgical management (group B) with regard to the
success, mortality, morbidity and short term follow up.
All cases with left atrial thrombi or mitral valve thrombosis on atrial side were
detected only by transosophageal echo, transthoracic echo were unable to detect such
pathology even with very large left atrial thrombi, but it can detect mitral valve
thrombosis with a large thrombus on the ventricular side in 2 patients.
All patients treated with thrombolytic therapy (group A/ 20 patients) were
bileaflet discs prosthetic valves except one patient was monolaflet. Also all patients
treated surgically (group B/ 20 patients) were also bileaflet discs prostheses except
one, so this study actually evaluates thrombolytic therapy as an alternative to redosurgery
in prosthetic mitral valves.