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World J Cardiol. Dec 26, 2015; 7(12): 875-881
Published online Dec 26, 2015. doi: 10.4330/wjc.v7.i12.875
Mechanical valve obstruction: Review of diagnostic and treatment strategies
Jason Salamon, Jerson Munoz-Mendoza, Jared J Liebelt, Cynthia C Taub
Jason Salamon, Jerson Munoz-Mendoza, Cynthia C Taub, Department of Cardiology, Montefiore Medical Center, Bronx, NY 10467, United States
Jared J Liebelt, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Author contributions: Salamon J was involved in researching, writing, editing and compiling this paper; Munoz-Mendoza J was involved in researching, writing, editing and compiling this paper; Liebelt JJ was involved in researching, writing, editing and compiling this paper; Taub CC was involved in researching, writing, editing and compiling this paper.
Conflict-of-interest statement: All the authors declare no conflict of interest in relation to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jason Salamon, MD, Department of Cardiology, Montefiore Medical Center, 211 E 210th Street, Bronx, NY 10467, United States. jason.salamon@med.einstein.yu.edu
Telephone: +1-718-9202117
Received: June 2, 2015
Peer-review started: June 4, 2015
First decision: August 8, 2015
Revised: September 13, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: December 26, 2015
Abstract

Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic evaluation should focus on differentiating prosthetic valve thrombosis (PVT) from pannus formation, as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient’s symptoms, valve location, degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively, pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology, epidemiology, diagnostic approach and treatment options for aortic and mitral valve PVO.

Keywords: Prosthetic valve thrombosis, Pannus overgrowth, Thrombolysis, Prosthetic valve obstruction, Echocardiography

Core tip: Prosthetic valve obstruction (PVO), while rare, is a dreaded complication of mechanical valve replacement. Careful clinical and multiple non-invasive imaging modalities are necessary to assess suspected PVO and evaluate for pannus overgrowth or valve thrombosis. Unlike pannus overgrowth, prosthetic valve thrombosis is more common, occurs earlier in the post-op period, is frequently related to inadequate anti-coagulation, and can often be treated through non-invasive thrombolysis. While the current understanding of pannus overgrowth remains elusive, future clarification of its pathophysiology may allow for the development of non-invasive therapeutic options.