Prosthetic Heart Valve Thrombosis

(Prosthetic Valve Thrombosis; PVT)

Definition

Prosthetic heart valve thrombosis is a rare, but serious complication of a heart valve replacement procedure. The complication occurs when a blood clot called a thrombus is attached to or near a prosthetic heart valve. This can obstruct blood flow or interfere with the function of the valve.Prosthetic heart valve thrombosis is a medical emergency.Heart Valves With Prosthetic Replacements
BP00039 97870 1 heart valve.jpg
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Causes

Prosthetic heart valve thrombosis is thought to result from an interaction between components of blood and the prosthesis or blood flow in and around the prosthesis.

Risk Factors

Factors that may increase your chance of prosthetic heart valve thrombosis include:
  • Inadequate anticoagulant/blood thinning therapy after a valve transplant
  • Prosthesis located at the mitral valve in the heart
  • Atrial fibrillation
  • Medications, such as contraceptives
  • Cancerous tumors
  • Systemic diseases such as systemic lupus erythematosus, or inflammation and damage to various body tissues, including joints, skin, kidneys, heart, lungs, blood vessels, and brain
  • Reduced cardiac pumping—possibly from heart failure

Symptoms

Prosthetic heart valve thrombosis may cause:
  • Shortness of breath
  • Difficulty breathing while lying down
  • Swelling
  • Fatigue
  • Difficulty exercising
  • Chest pain, burning, or pressure
  • Nausea
  • Numbness
  • Loss of consciousness

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam may be done. Images evaluate your heart and surrounding structures. These may include:Your bodily fluids may need to be tested. This can be done with blood tests.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Thrombolysis

The first line of therapy is usually thrombolysis, which are medications that break up abnormal blood clots.

Anticoagulation Therapy

Anticoagulant medications are used to control clotting. Anticoagulation therapy may be used alone in people with small clots that are not obstructing the heart valve.

Valve Replacement

In some cases, surgery to replace the valve may be necessary.

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Prevention

In people who have prosthetic heart valves, antithrombotic therapy is the best proven way to reduce your chance of prosthetic heart valve thrombosis.

RESOURCES

American Heart Association
http://www.heart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Heart Research Centre
http://www.chrc.net

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References

Prosthetic heart valve dysfunction. DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 19, 2014. Accessed September 26, 2014.

Serpi M, Schmidt KG, Kreuz W, et al. Thrombolysis of prosthetic heart valve thrombosis using recombinant tissue plasminogen activator (rt-PA) in infancy and childhood. Z Kardiol. 2001;90(3):191-196.

Roudant R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93:137-142.

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