Prosthetic valve (thrombosis / dehiscence)

What is it?

A valve prosthesis can develop a complication some time after it has been implanted. Thrombosis is the formation of a clot that restricts the movement of the prosthesis; it occurs mainly when anticoagulation is insufficient. Dehiscence is a partial detachment of the prosthesis from its ring, causing a leak around the valve. Both situations require prompt assessment in a specialised centre.

Step by step

1. 1

   The work-up includes an echocardiogram, most often through the oesophagus, and a check of anticoagulation (INR, a measure of how effective the blood-thinning treatment is).

2. 2

   An additional imaging test may be requested to analyse the movement of the moving parts of the prosthesis.

3. 3

   The course of action is decided in a joint medical and surgical meeting, based on the mechanism, the size of the clot and your clinical condition.

4. 4

   For thrombosis, treatment may consist of intensified anticoagulation or of fibrinolysis (medication intended to dissolve the clot), given in intensive care under continuous monitoring.

5. 5

   Repeat surgery is indicated in certain situations: it is performed under general anaesthesia with a heart-lung machine. The surgeon removes the clot, re-secures the prosthesis, or replaces it.

6. 6

   Postoperative monitoring takes place in intensive care, with anticoagulant treatment resumed and adjusted.

Recovery and follow-up

The length of hospital stay depends on the treatment chosen, medical or surgical. Anticoagulation is reassessed and monitored more closely: INR tests at short intervals at first, then at regular intervals. A control echocardiogram checks the function of the prosthesis before discharge and during follow-up. Adherence to blood tests and prescribed doses is the main element in preventing a recurrence.