![]() Chest roentgenograph showed a cardiothoracic ratio >0.55 in 17 patients (35.4%). Electrocardiogram was abnormal in 37 cases (77.1%), including atrial fibrillation in 23 (47.9%), ventricular hypertrophy in 10 (20.8%) and ventricular premature beat in 4 (8.3%). The clinical presentation varied considerably from dyspnea and palpitation with changes in valve clicks on auscultation to sudden onset of ventricular fibrillation immediately following the primary valve replacement. Table 2 Details of prostheses used in the primary valve replacement The median time from the primary valve replacement to onset of symptoms or diagnosis and to reoperation was 44.5 months (range, 1 hour to 20 years) and 51 months (range, 1.1 hours to 23 years), respectively while the median interval from symptomatic onset or diagnosis to reoperation was 2 months (range, 0.1 hour to 61 months) ( Table 1). The Ethics Committee of Fu Wai Hospital and Cardiovascular Institute approved this retrospective study and waived the need for individual patient consent for this study. In this retrospective study, we seek to report our experience with surgical management of this group of patients with emphasis on etiology, surgical strategy and early outcomes. Among these there were 48 (0.28%) cases of reoperations for mechanical heart valve dysfunction. An algorithm for management of obstructive thrombosed prosthetic heart valve has been developed recently ( 4).īetween October 1996 and June 2011, a total of 16,893 cases of mechanical heart valve replacement were performed in our institute. Numerous studies have been carried out to identify the risk factors for prosthetic valve dysfunction ( 2- 13). Accepted for publication Dec 02, 2015.Īlthough the long-term outcome of mechanical value replacement have improved significantly with the progress of materials, design, manufacturing and surgical techniques, prosthetic valve dysfunction remains a very serious complication after mechanical valve replacement with high mortality and morbidity ( 1). Keywords: Mechanical heart valve prosthesis dysfunction surgery reoperation outcome The high incidence of thrombosis in this series highlights the need for adequate anticoagulation and regular follow-up after mechanical valve replacement. Earlier identification and prompt reoperation are vital to achieving better clinical outcomes. Complications occurred in 10 patients (20.8%).Ĭonclusions: Surgical management of mechanical valve dysfunction is associated with significant mortality and morbidity. Early deaths occurred in 7 patients (14.6%), due to low cardiac output in 3 (6.3%), multi-organ failure in 2 (4.2%) and refractory ventricular fibrillation in 2 (4.2%). Surgical procedure was mechanical valve replacement in 37 cases (77.1%), bioprosthetic valve replacement in 7 (14.9%), disc rotation in 2 (4.2%) and excision of excessive knot end in 1 (2.1%). The etiology was thrombosis in 19 cases (39.6%), pannus in 12 (25%), thrombosis and pannus in 11 (22.9%), improper disc orientation in 2 (4.1%), missing leaflet in 1 (2.1%), excessively long knot end in 1 (2.1%), endogenous factor in 1 (2.1%) and unidentified in 1 (2.1%). ![]() There were 21 emergent and 27 elective reoperations. The median interval from primary valve implantation to dysfunction was 44.5 months (range, 1 hour to 20 years). Results: Mean age was 43.7☑0.9 years and 34 were female (70.8%). Methods: Clinical data of 48 patients with mechanical valve dysfunction surgically treated between October 1996 and June 2011 were analyzed. We seek to report our experience with mechanical valve dysfunction regarding etiology, surgical techniques and early outcomes. Interviews with Outstanding Guest Editorsīackground: Dysfunction of mechanical heart valve prostheses is an unusual but potentially lethal complication after mechanical prosthetic valve replacement. ![]()
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