This chapter about the use of antithrombotic agents during pregnancy is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understand...

A 90 year-old male patient, known to have severe aortic stenosis (AS), was admitted with chest pain, shortness of breath and swelling of both lower limbs. He had history of ischemic heart disease and percutaneous coronary intervention (PCI) of left anterior descending artery (LAD) in 2002. He also had long standing hypertension, primary hypothyroidism and hypercalcemia. He had a permanent pacem...

1. Permanent therapy with oral anticoagulants offers the most consistent protection in patients with mechanical heart valves. 2. Antiplatelet agents alone do not consistently protect patients with mechanical prosthetic heart valves, including patients in sinus rhythm with St. Jude Medical valves in the aortic position. 3. Levels of oral anticoagulants that prolong the INR to 2.0 to 3.0 appear s...

Objective: Evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. Method: From January 2001 to December 2002, 15 patients with previous mitral operation, small left atrium and atrial fibrillation underwent mitral valve surgery through an extended vertical transseptal incision. There were nine women and six men. Their ages ranged...

Current artificial heart valves either have limited lifespan or require the recipient to be on permanent anticoagulation therapy. In this paper, effort is made to assess a newly developed bileaflet valve prosthesis made of synthetic flexible leaflet materials, whose geometry and material properties are based on those of the native mitral valve, with a view to providing superior options for mitr...

Reoperation is the method of choice for correcting prosthetic paravalvular leaks. The percutaneous repair of mitral paravalvular leaks might represent an interesting alternative in select cases. The present study reports two cases of mitral paravalvular leaks that were treated with AmplatzerTM Vascular Plug III guided by three-dimensional (3D) transesophageal echocardiography, using the percuta...

OBJECTIVE Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de São Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomédica® aortic bioprosthesis in patients with aortic valve disease. METHODS We retrospectively evaluated 196 patients with aortic valve disease ...

Recently, several new anticoagulants have been used instead of warfarin for preventing thromboembolism. In the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, the direct thrombin inhibitor dabigatran etexilate was as an effective and safe as dose-adjusted warfarin for prevention of stroke in high-risk patients with atrial fibrillation. However, the safety and efficacy ...

Prosthetic valve endocarditis (PVE) represents an uncommon and very serious complication after heart valve surgery. Prosthetic valve endocarditis occurs in 1% to 6% of patients with valve prostheses and affects both mechanical and biological valves [1]. Up to 34% of all cases of infective endocarditis involve prosthetic heart valves. Prosthetic valve endocarditis represents a nosographic entity...

Introduction: Prosthetic valve thrombosis is a rare and severe complication of valve replacement, most often encountered with a mechanical prosthesis. The significant morbidity and mortality associated with this condition warrant rapid diagnostic evaluation. Although surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as a...