TO STUDY THE CLINICAL AND ETIOPATHOLOGICAL PROFILE IN PROSTHETIC VALVE DYSFUNCTION-A SINGLE CENTRE EXPERIENCE.

Abstract

Valvular heart disease affects millions has significant morbidity and mortality, further increased even after valve replacement when associated with Prosthetic valve dysfunction(PVD). The risk of Prosthetic valve thrombosis(PVT) and thromboembolic events is higher for prosthetic valve(PV) in mitral position. The annual incidence rate of PVT ranges from 0.1% to5.7%. Determining the main etiology of PVD is crucial as the treatment differs for each also its important to identify the optimal antithrombotic therapies to prevent PVD/PVT. In our observational study, 32 patients enrolled. (21)65.6% are female and (11)34.4% males with age from 20 to 66 yrs. Most PVD noted in Mitral Valve(93.8%). Non obstructive Prosthetic Valve Thrombosis is most common PVD seen in 16(50%)patients, 8(25%) had obstructive Prosthetic Valve Thrombosis, 6(18.75%) had Prosthetic Valve Endocarditis/vegetations, 2(6.25%) had pannus formation.Thromboembolic features seen in 3 patients. 12(37.5%) patients are asymptomatic, 6(18.75%) with mild dyspnea and 6(18.75%) with heart failure and shock. Mean INR is 1.58±0.6 with only 5(15.62%) on therapeutic range. The mean INR with Non obstructive PVT is 1.91±0.4 and with obstructive PVT is 1.0±0.2. 27(84.36%) on lower side of therapeutic INR and the frequency of monitoring is less. 18(56.25%) had normal PV gradient and the gradient increased in 14(43.75%) patients. The mean mitral valve (MV) gradient is 9.5±6.9, MV Vmax 2.2±0.6, MV VTI 2.5±0.6, MV PHT 158±91.9, MV EOA 1.65±0.8. Thrombus size varies from 2 to 8.1mm in diameter. 26 patients had TTK chitra valve and 6 patients with St Jude- bileaflet, and data is limited to compare both. On treatment 6 patients underwent thrombolysis, 2 reoperated, 24 heparinized and acitrom dose titred , one patient expired, 6 patients with PV endocarditis/vegetation managed with higher antibiotics and anticoagulation. Prosthetic valve dysfunction is not uncommon. Non obstructive PVT is the commonest PVD noted missed PVT results in increased mortality