J Heart Valve Dis
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The study aim was to determine the risk of thromboembolic and bleeding complications in patients with mechanical heart valve prostheses who underwent non-cardiac surgery under different regimens of perioperative anticoagulation. Data were analyzed on the basis of surgery type and underlying disease. ⋯ Minor surgical procedures can be performed safely without discontinuing anticoagulation. When major non-cardiac surgery is planned, discontinuing oral anticoagulation and starting perioperative intravenous heparin minimizes bleeding and thromboembolic risks. Thromboembolic complications may occur within one month of surgery, despite adequate oral anticoagulation, though permanent morbidity is low.
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Case Reports
Asymptomatic left ventricular outflow tract obstruction after mitral valve replacement with leaflet preservation.
It has been shown that inappropriate anterior mitral leaflet preservation during mitral valve replacement may cause left ventricular outflow tract (LVOT) obstruction, usually with dismal prognosis. In this report, we describe a patient with chronic asymptomatic LVOT obstruction after mitral valve replacement with leaflet preservation.
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Comparative Study
Effectiveness of continuous warm blood cardioplegia in cardiac valve re-replacement.
In order to achieve better operative results, myocardial protection for cardiac valve re-replacement must be further improved. The aim of this study was to compare the efficacy of continuous warm blood cardioplegia (CWBC) with that of intermittent cold potassium cardioplegia (ICPC) in cardiac valve re-replacement. ⋯ In cardiac valve re-replacement surgery through sternal re-entry, and without wide exposure of the heart, continuous warm blood cardioplegia provides much greater myocardial protection than does intermittent cold potassium cardioplegia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Thrombolysis is superior to heparin for non-obstructive mitral mechanical valve thrombosis.
Non-obstructive prosthetic valve thrombosis (PVT) is a unique subset that features clinical presentation without heart failure, and may be asymptomatic. Thrombolysis has been accepted for obstructive PVT, but treatment strategies of non-obstructive PVT are controversial. This study compared the efficacy and safety of thrombolysis and heparin treatment in these patients. ⋯ Non-obstructive PVT may be asymptomatic in one-third of patients. Thrombolysis is an efficient and safe treatment, and may be first-line therapy if there is no contraindication. Heparin treatment was successful in about one-half of our cases in the presence of sessile or small thrombi and inadequate anticoagulant status. In unsuccessful cases, thrombi became obstructive or caused stroke during heparin therapy, the adequate duration of which remains unclear.