Station 3.7: Prosthetic valves: aortic and mitral Flashcards
Prosthetic valves: aortic and mitral
Clinical signs
What are the clinical signs for Prosthetic valves: aortic and mitral?
Prosthetic valves: aortic and mitral
This patient has recently been treated for dyspnoea/chest pain/syncope. Please examine his cardio-vascular system.
- Audible prosthetic clicks (metal) on approach and scars on inspection
- Auscultation: don’t panic!
- Anticoagulation: bruises (metal valve) and anaemia
- Midline sternotomy (CABG, AVR, MVR)
- Lateral thoracotomy (MVR, mitral valvotomy, coarctation repair, BT shunt)
- Subclavicular (Pacemaker, AICD)
- Anticubital fossa (angiography)
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Discussion - choice of valve replacement
What are the choices of valve replacement for Prosthetic valves: aortic and mitra?
Prosthetic valves: aortic and mitral
his patient has recently been treated for dyspnoea/chest pain/syncope. Please examine his cardiovascular system.
Discussion - Late complications
What are the choices of valve replacement for Prosthetic valves: aortic and mitra?
Prosthetic valves: aortic and mitral
his patient has recently been treated for dyspnoea/chest pain/syncope. Please examine his cardiovascular system.
- Thromboembolus: 1–2% per annum despite warfarin
- Bleeding: fatal 0.6%, major 3%, minor 7% per annum on warfarin
- Bioprosthetic dysfunction and LVF: usually within 10 years, can be treated percutaneously (valve‐in‐valve)
- Haemolysis: mechanical red blood cell destruction against the metal valve
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Infective endocarditis:
⚬ Early infective endocarditis (<-2/12 post‐op) can be due to Staphylococcus epidermidis from skin
⚬ Late infective endocarditis is often due to Strep. viridans by haematogenous spread
⚬ A second valve replacement is usually required to treat this complication
⚬ Mortality of prosthetic valve endocarditis approaches 60% - Atrial fibrillation: particularly if MVR
