INTRODUCTION Turbulence, characterized by velocity fluctuations, is a sign of suboptimal hemodynamics in prosthetic heart valves [1]. Turbulence causes pressure drops and exposes endothelial cells and blood constituents to abnormal stresses which can lead to blood trauma and promote the pathogenesis of atherosclerosis. Phase-contrast MRI (PC-MRI) has previously been shown to be valuable for the...

To the Editor: Pregnant women with mechanical heart valves are an ultrahigh-risk group, in whom all anticoagulant options pose maternal and/or fetal risks. It is unclear why the authors of the recent update1 selected 4 studies, neither the most recent nor of the highest quality, to give a warfarin embryopathy rate of 1.6%. This anomaly rate is not supported by evidence in their Table 1 (3.9% of...

This paper describes "how to" examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, "how to" perform and optimize a multislice CT scan and "how to" interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease...

BACKGROUND Cardiac disease in pregnancy is a common problem in under-resourced countries and a significant cause of maternal morbidity and mortality. A large proportion of patients with cardiac disease have prosthetic mechanical heart valve replacements, warranting prophylactic anticoagulation. AIM To evaluate obstetric outcomes in women with prosthetic heart valves in an under-resourced coun...

The combination of heart disease and pregnancy can present a formidable challenge to the clinician entrusted to care for both the mother and fetus. Since most data is retrospective, a definitive prognosis for such a patient may be difficult to obtain. Nevertheless, certain cardiac conditions carry greater risks of maternal mortality than do others. However, even for certain preexisting conditio...

Valve replacement remains common in the adult patient despite advances in valve repair. While a physical examination can alert the clinician to the presence of valve dysfunction, diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography with Doppler is currently the method of choice for non-invasive evaluation of prosthetic valves. A recently published "Guid...

The management of pregnant women with mechanical heart valves is challenging. Recently, based on small numbers of patients and poor-quality data, correspondence from Aventis Pharmaceuticals Inc has described treatment "failures" and concerns about teratogenicity with the use of the low-molecular-weight heparin (LMWH) enoxaparin. The company issued a "Warning" that enoxaparin should not be used ...

T he management of pregnant women with mechanical heart valves is challenging. Recently, based on small numbers of patients and poor-quality data, correspondence from Aventis Pharmaceuticals Inc has described treatment “failures” and concerns about teratogenicity with the use of the low-molecular-weight heparin (LMWH) enoxaparin. The company issued a “Warning” that enoxaparin should not be used...

The evaluation of prosthetic valves can provide a unique challenge, and a thoughtful approach is required. High output states like anemia should be kept in the differential when evaluating elevated gradients across prosthetic valves. We present the case of a 69-year-old man with a Starr-Edwards prosthetic aortic valve who presented with symptoms of congestive heart failure and high transvalvula...