Abstract
Background and Objectives: Malfunction of Prosthetic Heart Valve is one of the most dangerous side effects for patients who receive them. The incidence of prosthetic thrombosis was % 0.1 a year in aorta and % 0.35 in mitral valve status. This side effect almost in all occasions occurs because of undesirable anti coagulation therapy. Surgical therapy is the major intervening one which is associated with the highest mortality and morbidity risk. And Thrombolitic therapy has always been a matter of discrepancy as a surgical therapy alternative. In this ten-year study we intended to review the results of surgical therapy interventions with those of Thrombolitic therapy in patients hospitalized with malfunction of heart valve. Our analysis is not based on a randomized study design but is a retrospective analysis of non selected patients.
Material and Methods: In this study we reviewed 65 patients who were hospitalized and treated at Shahid Madani Hospital for the malfunction of prosthetic metal heart valve from 1996 to 2005. The etiology of the malfunction of the valve, clot status at the time acceptance, clinical signs, the kind of therapy used together with the assessment of the interventions of surgical therapy and thrombolitic therapy were extracted and the results were reported as frequency percentages.
Results: Out of 65 patients 46 (%70.7) had prosthetic mitral valve and 19 patients (% 29.3) had prosthetic aorta valve. The clinical signs of 54 cases (%83) were recorded aspiration problems, 5 cases (%7) reduction of palpation sound of the prosthetic valve, 4 cases (%6 ) environmental embolisms and 2 cases (%3) had palpation problems and in 57 patients (%88) INR was reported to be lower than the therapy level. In these patients 17 cases had received thrombolitic therapy of whom 11 patients (%84.6) were recorded to show positive response to therapy and 3 cases (%17.6) showed incomplete reaction and candidate for surgical therapy and 3 cases (%17.6) death were recorded. The cases with surgical therapy had significant differences (P<%5). The surgical therapy was performed in 51 patients of whom 10 (%20) died, which was significantly more than mortality and morbidity in medical therapy group (P< %5). During therapy 30 cases were reported with Thrombus, 11 cases with Panus and 10 cases with Thrombus on Panus.
Conclusion: Treatment with Thrombolitic in most cases of acute Thrombosis of prosthetic metal left valves, especially in acute cases (a short time after the symptoms started) proves to be efficient, especially considering the fact that emergency surgery, which has the probability of many side effects and with a high degree of mortality and morbidity, seems to be vital.