Table 30. Prosthetic Valve Complications
Recommendations
Prosthetic Valve rombosis
TTE is indicated in patients with suspected prosthetic valve
thrombosis to assess hemodynamic severity and follow
resolution of valve dysfunction.
I B
TEE is indicated in patients with suspected prosthetic valve
thrombosis to assess thrombus size and valve motion.
I B
Fluoroscopy or CT is reasonable in patients with suspected
valve thrombosis to assess valve motion.
IIa C
Fibrinolytic therapy is reasonable for patients with a
thrombosed le-sided prosthetic heart valve, recent onset
(<14 days) of NYHA class I-II symptoms, and a small
thrombus (<0.8 cm
2
).
IIa B
Fibrinolytic therapy is reasonable for thrombosed right-sided
prosthetic heart valves.
IIa B
Emergency surgery is recommended for patients with a
thrombosed le-sided prosthetic heart valve with NYHA
class III-IV symptoms.
I B
Emergency surgery is reasonable for patients with a
thrombosed le-sided prosthetic heart valve with a mobile
or large thrombus (>0.8 cm
2
).
IIa C
Prosthetic Valve Stenosis
Repeat valve replacement is indicated for severe symptomatic
prosthetic valve stenosis.
I C
Prosthetic Valve Regurgitation
Surgery is recommended for operable patients with
mechanical heart valves with intractable hemolysis or HF due
to severe prosthetic or paraprosthetic regurgitation.
I B
Surgery is reasonable for operable patients with severe
symptomatic or asymptomatic bioprosthetic regurgitation.
IIa C
Percutaneous repair of paravalvular regurgitation is reasonable
in patients with prosthetic heart valves and intractable
hemolysis or NYHA class III/IV HF who are at high risk for
surgery and have anatomic features suitable for catheter-based
therapy when performed in centers with expertise in the
procedure.
IIa B
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