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Prosthetic Cardiac Valve Replacement: Management Problems

Department of Internal Medicine 1 Department of Cardiology 2 Department of Pathology Postgraduate Institute of Medical Education and Research Chandigarh, India

For reprint information contact: Anil Grover, DM Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh 160012, India Tel: 91 172 54 1032 Ext. 380 Fax: 91 172 54 0401 Email: medinst{at}pgi.chd.nic.net.in.

Altered states of coagulability can be precarious for patients with valvular prostheses. Prosthetic valvular thrombosis can produce devastating hemodynamic changes wherein surgical intervention might be high risk. We describe the cases of 4 patients with prosthetic cardiac valve replacements to highlight some of the problems that might be encountered. The first patient suffered prosthetic valve thrombosis following withdrawal of her anticoagulants during labor. She was treated with urokinase but failed to survive. The second young female suffered two episodes of valvular thrombosis and was successfully treated with streptokinase on the first occasion but succumbed one year later during the second episode. The third patient was an elderly male who suffered an intracerebral hemorrhage as a result of an increase in anticoagulant dosage. He was successfully managed with low molecular weight heparin. In the fourth case, a young female with a prosthetic mitral valve had a favorable clinical outcome in spite of withdrawal of anticoagulants during labor.