Roll no: 24 Introduction • Early mortality rate has remained stable for more than 10 years. • Mechanical valves appear to be a better option for some patients. • For young adults and patients with end-stage renal disease because of the more rapid onset of structural dysfunction of tissue valves. • Unfavourable complications can occur after valve surgery. Thromboembolism and bleeding complications • Related to the use of warfarin anticoagulation therapy. • Other causes: Intrinsic coagulation factors, intestinal lesions, atrial enlargement, arrhythmias such as atrial fibrillation. • Risk factors: Preoperative history of cerebrovascular events. • Associated with high mortality and morbidity rates. Endocarditis
• Occurrence rate is approximately 0.5 % per patient-year.
• Early PVE , occurring <60 days from valve surgery, usually results from contaminated surgical devices or a postoperative wound infection, common bacteria are staph epedermidis, staph aureus, and gram negative bacteria. Endocarditis Risk factors for PVE are;
• -multiple valves
• -antecedents native valve endocarditis
Signs and symptoms are similar to those in native valve endocarditis.
Fever in a patients with a PV should be considered endocarditis until proved otherwise . Structural Valve failure
• Structural valve failure is essentially confined to bio
prosthetic valves with one historical exception:
The Bjork-Shiley single tilting disk was withdrawn from use
in 1986 after reports of strut fracture. Structural Valve failure Strut Fractures in Bjork-Shiley Valve (Ref 1) Non-Structural Dysfunction • Includes paravalvular leaks without apparent endocarditis, cusp entrapment by a pannus or other causes. • 0.4–1.2 % per patient-year among recent mechanical heart valves. Caused by: • Technical errors • Latent prosthetic endocarditis or annular calcification. Clinical signs: • Stenosis • Echocardiogram* References • Misawa Y. Valve-related complications after mechanical heart valve implantation. Surgery today. 2015 Oct 1;45(10):1205-9. • Rambod E, Isaacian M, inventors; BIOQUANTETICS Inc, assignee. Non-invasive technique for identification of structural integrity of Bjork Shiley convexo-concave mechanical heart valves. United States patent US 8,109,876. 2012 Feb 7. Thank you.