Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week. [Review] 

 -  2023 
<br/><br/>Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007 
<br/><br/> Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomography, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Transcatheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation. Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>0735-1097 
<br/><br/><label>Standard No.: </label>10.1016/j.jacc.2023.03.412 [doi] S0735-1097(23)05225-7 [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Bioprosthesis<br/>*Heart Valve Prosthesis<br/>*Thrombosis<br/>Anticoagulants/tu [Therapeutic Use]<br/>Heart Valve Prosthesis/ae [Adverse Effects]<br/>Heart Valves<br/>Humans<br/>Thrombosis/di [Diagnosis]<br/>Thrombosis/et [Etiology]<br/>Thrombosis/th [Therapy]--Automated
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute<br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Cardiovascular Disease Fellowship
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Review