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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Transesophageal Echocardiography Improves Risk Assessment of Thrombolysis of Prosthetic Valve Thrombosis: Results of the International PRO-TEE Registry
Journal of the American College of Cardiology, Volume 43, No. 1, Year 2004
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Description
OBJECTIVES: The goal of this study was to evaluate whether quantitation of thrombus burden with transesophageal echocardiography (TEE) can help risk-stratify patients undergoing thrombolysis of prosthetic valve thrombosis (PVT). BACKGROUND: Thrombolytic therapy of PVT has an unpredictable risk of embolization and complications. METHODS: An international registry of patients with suspected PVT undergoing two-dimensional/ Doppler and TEE before thrombolysis was established. All TEE studies were reviewed and quantitated by a single observer blinded to all data. RESULTS: From 1985 to 2001, 107 patients (71 females; age 24 to 86 years) from 14 centers (6 in the U.S.) were identified. The majority of cases involved the mitral valve (79 mitral, 13 aortic, and 15 tricuspid). Hemodynamic success rate was achieved in 85% and was similar across valves. Overall complications were observed in 17.8%, and death in 5.6%. Predictors of complications were: New York Heart Association (NYHA) functional class, presence of shock, sinus tachycardia, hypotension, previous history of stroke, thrombus extension beyond the valve ring, and thrombus area. Multivariate analysis demonstrated that two variables were independent predictors of complications: thrombus area by TEE (odds ratio [OR] 2.41 per 1 cm2 increment, 95% confidence interval [CI] 1.12 to 5.19) and prior history of stroke (OR 4.55, 95% CI 1.35 to 15.38). A thrombus area <0.8 cm2 identified patients at lower risk for complications from thrombolysis, irrespective of NYHA functional class. CONCLUSIONS: In PVT, the thrombus size imaged with TEE is a significant independent predictor of outcome. Transesophageal echocardiography can identify low-risk groups for thrombolysis irrespective of symptom severity and is therefore recommended in the management of prosthetic valve thrombosis. © 2004 by the American College of Cardiology Foundation.
Authors & Co-Authors
Tong, Ann T.
United States, Houston
Baylor College of Medicine
Roudaut, Raymond P.
France, Pessac
Hopital Haut-lévêque C.h.u de Bordeaux
Ozkan, Mehmet
Turkey, Istanbul
Kosuyolu Heart Education and Research Hospital
Sagie, Alex
Israel, Petah Tiqwa
Rabin Medical Center Israel
Alshahid, Maie
Saudi Arabia, Riyadh
King Faisal Specialist Hospital and Research Centre
Pontes, Sergio C.
Brazil, Sao Paulo
Instituto Dante Pazzanese de Cardiologia
Carreras, Francesc
Spain, Barcelona
Hospital de la Santa Creu I Sant Pau
Girard, Steven E.
United States, Rochester
Mayo Clinic
Arnaout, Mohammad Samir
Lebanon, Beirut
American University of Beirut
Stainback, Raymond F.
United States, Houston
Texas Heart Institute
Thadhani, Ravi Ishwar
United States, Boston
Massachusetts General Hospital
Zoghbi, William A.
United States, Houston
Baylor College of Medicine
United States, Houston
Houston Methodist
Statistics
Citations: 215
Authors: 12
Affiliations: 12
Identifiers
Doi:
10.1016/j.jacc.2003.08.028
ISSN:
07351097
Research Areas
Noncommunicable Diseases
Study Design
Case-Control Study
Participants Gender
Female