45
Acute Mechanical Prosthetic Valve Thrombosis
Table 29. Mechanical Prosthetic Valve Thrombosis Diagnosis
and Follow-Up (2017)
Recommendation COR LOE
Urgent evaluation with multimodality imaging is indicated
in patients with suspected mechanical prosthetic valve
thrombosis to assess valvular function, leaflet motion, and the
presence and extent of thrombus.
I B-NR
Table 30. Mechanical Prosthetic Valve Thrombosis
Intervention (2017)
Recommendation COR LOE
Urgent initial treatment with either slow-infusion low-dose
fibrinolytic therapy or emergency surgery is recommended for
patients with a thrombosed le-sided mechanical prosthetic
heart valve presenting with symptoms of valve obstruction.
I B-NR
Table 31. Prosthetic Valve Stenosis
Recommendations COR LOE
Repeat valve replacement is indicated for severe symptomatic
prosthetic valve stenosis.
I C
In patients with suspected or confirmed bioprosthetic valve
thrombosis who are hemodynamically stable and have no
contraindications to anticoagulation, initial treatment with a
VKA is reasonable. (New recommendation for 2017)
IIa C-LD
For severely symptomatic patients with bioprosthetic aortic
valve stenosis judged by the heart team to be at high or
prohibitive risk of reoperation, and in whom improvement in
hemodynamics is anticipated, a transcatheter valve-in-valve
procedure is reasonable. (New recommendation for 2017)
IIa B-NR
