ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Valve-in-ring Mitral. Postoperative Valve Thrombosis. How To Manage?
Gry Dahle, Thomas Helle-Valle, Jan Otto Beitnes, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.

OBJECTIVE:

  • Postoperative CT scan has revealed reduced aortic valve leaflet motion in bioprosteses
  • Clinical effects could be valve thrombosis and cerebral stroke
  • Valve thrombosis has been reported following transcatheter mitral valve implantation (TMVI) and for this reason valves have been withdrawn
  • How to prevent valve thrombosis?
  • Coumadine treatment lifelong postopertively may prevent?
  • We report a patient with valve thrombosis in a TMVI after swithching from Coumadine to NOAC (new oral anticoagulant)
    METHODS: A female of 64 years had a valve-in-ring procedure due to failing annuloplasty. Initially good result. She was in atrial fibrillation and on NOAC before procedure, after we switched to Coumadin. After three months she was back on NOAC and in the following three weeks she developed increasing dyspnoea. Evaluation with CT scan and Echo (3D) revealed Valve thrombosis.Treatment with actilysis was initiated with no improvement. A transapical redo procedure was done with a second catheter valve implantedVideo from procedure available
    RESULTS: The procedure was successful and the gradient reduced from 12mmHg to 4 mmHg. Uneventful postoperative and clinical improvement
    CONCLUSIONS:
  • Valve thrombosis is known to occur in bioprostheses
  • For mitral procedures with valve-in-valve/ring lot of stent material ( metal and tissue) is introduced into the heart
  • Coumadine seems to prevent thrombus formation
  • NOAC does not prevent thrombus formation
  • Maybe patients with mitral bioprostheses should have lifelong anticoagulation

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