BACKGROUND The management of women with prosthetic heart valves during pregnancy poses a particular challenge as there are no available controlled clinical trials to provide guidelines for effective antithrombotic therapy. Oral anticoagulants such as warfarin sodium cause fetal embryopathy; subcutaneous administration of heparin sodium has been reported to be ineffective in preventing thromboem...

An Alvarez disc valve prosthesis had been implanted in the mitral and tricuspid positions in 15 patients between 1964 and 1967 in this hospital. Of these 15 patients, only three survived longer than 10 years, all three dying unexpectedly between 16 and 18 years postoperatively. Two deaths were a direct result of disruption of the Alvarez prosthesis. The third patient was not examined at necrops...

BACKGROUND Variability in the intensity of anticoagulant therapy is considered a risk factor for complications, but it is unclear how best to quantify variability. OBJECTIVE We evaluated the association of three methods to measure variability with complications of oral anticoagulant therapy. METHODS We conducted a nested case-control study within a cohort of patients with prosthetic heart v...

OBJECTIVE To investigate whether patients with heart valve prostheses and similar International Normalized Ratios (INR) have the same level of protection against thromboembolic events, that is, whether the anticoagulation intensity is related to the intensity of hypercoagulability suppression. METHODS INR and plasma levels of prothrombin fragment 1+2 (F1+2) were assessed in blood samples of 2...

BACKGROUND The United Kingdom Heart Valve Registry (UKHVR) has recently completed collecting information on 52 659 heart valve replacements (in 47 718 patients) performed during the period 1986 to 1995 in the whole of the United Kingdom. Information stored in the UKHVR's computer database was used for this study. Factors affecting the time from first prosthesis to first redo prosthesis were ana...

background: the evaluation of prosthetic valves is very difficult with two-dimensional transthoracic echocardiography alone. doppler and color flow imaging as well as transesophageal echocardiography are more reliable to detect prosthetic valve dysfunction. however, doppler study sometimes tends to be misleading due to the load-depending characteristics of peak and mean pressure gradients. the ...

Catheter radiofrequency ablation of the atrial fibrillation substrate may be difficult in patients after open heart surgery. Difficulties arise presence a mitral valve prosthesis, arrhythmias several morphologies (more often left atypical flutter), including incisional ones. These cases require thorough and scrupulous approach to achieve complete isolation all available arrhythmia substrates. A...

We read with great interest the report by Carnero-Alcazar and co-workers regarding the successful mechanical mitral valve replacement due to pros-thetic valve thrombosis in a first trimester pregnant woman w1x. Two percent of all pregnant women suffer from some kind of cardiac pathology. Although this incidence varies in different countries, cardiac disease is the leading cause of death in preg...