Download Prosthetic heart valves

Prosthetic heart valves:
management of usual and unusual
complications
January 14th, 2016
14h-15h30
What is the risk of thromboembolic events (per year)
in patients with mechanical prosthetic heart valve?
A) 0,05 to 0,5%
B) 1 to 2%
C) 3 to 4%
D) 8%
What is the risk of thromboembolic events (per year)
in patients with mechanical prosthetic heart valve?
A) 0,05 to 0,5%
B) 1 to 2%
C) 3 to 4%
D) 8%
What is the first exam to perform when you
suspect a prosthetic valve thrombosis on TTE?
A) Transoesophageal Echocardiography
B) CT scan
C) Fluoroscopy
D) None, TTE is sufficient
What is the first exam to perform when you
suspect a prosthetic valve thrombosis on TTE?
A) Transoesophageal Echocardiography
B) CT scan
C) Fluoroscopy
D) None, TTE is sufficient
Explanations
Transoesophageal Echocardiography in emergency is the first
option when suspicion of prosthetic valve thrombosis according
to ESC 2012 and ACC/AHA 2014 guidelines.
CT scan and Fluoroscopy may also be performed, but after TOE
(class IIa C)
What is (are) the correct proposition(s) about
pannus:
A) Only appears on mechanical prosthesis
B) Diagnosis can only be made after surgery
C) More frequent on the ventricular side of prosthetic valves
D) More frequent on aortic than mitral prosthetic valves
What is (are) the correct proposition(s) about
pannus:
A) Only appears on mechanical prosthesis
B) Diagnosis can only be made after surgery
C) More frequent on the ventricular side of prosthetic valves
D) More frequent on aortic than mitral prosthetic valves
Explanations
A) though very rare, pannus can also be found on bioprosthetic
valves
B) Pannus diagnosis can be made with CT scan
C) More frequent on the ventricular side of prosthetic valves 
only true for aortic prosthetic valves. Pannus are more often on
the atrial side for mitral prosthesis.
Which of the following proposition(s) about
prosthetic valve endocarditis is/are correct?
A) Can benefit from ambulatory care with antibiotics administered
through a picc-line
B) The diagnosis may be difficult with non specific clinical signs and
negative blood culture
C) Trans-oesophageal echography (TOE) can show abcesses around the
valve, periprosthetic leak or desinsertion of the prosthesis
D) Staphylococcus is the most commonly found germ, in early and late
endocarditis
E) Cardiac surgeon especially like to operate on this kind of patients
Which of the following proposition(s) about
prosthetic valve endocarditis is/are correct?
A) Can benefit from ambulatory care with antibiotics administered
through a picc-line
B) The diagnosis may be difficult with non specific clinical signs and
negative blood culture
C) Trans-oesophageal echography (TOE) can show abcesses around
the valve, periprosthetic leak or desinsertion of the prosthesis
D) Staphylococcus is the most commonly found germ, in early and
late endocarditis
E) Cardiac surgeon especially like to operate on this kind of patients
Explanations
A) Treament is initiated during the hospitalization
and continued home with a picc-line
B) Cardiac device-related infective endocarditis is one of the
most difficult forms of IE to diagnose with misleading symptoms
(IE Guidelines 2015)
C) TOE show vegetation, abscess or pseudoaneurysm and new
dehiscence of a prosthetic valve (IE Guidelines 2015)
D) Staphylococci found in 31% of cases (Murdoch DR et al Arch Intern Med
2009;169:463-73)
Which of the following proposition(s) about infective
endocarditis (IE) on percutaneous pulmonary valve
Melody® is/are correct?
1) The risk is the same as a surgically implanted homograft
2) The risk is higher than in case of TAVI (aortic position)
3) Long-term low-dose aspirin therapy seems to decrease this
risk
4) May need an emergency intervention for acute valve
obstruction
Which of the following proposition(s) about infective
endocarditis (IE) on percutaneous pulmonary valve
Melody® is/are correct?
1) The risk is the same as a surgically implanted homograft
2) The risk is higher than in case of TAVI (aortic position)
3) Long-term low-dose aspirin therapy seems to decrease this
risk
4) May need an emergency intervention for acute valve
obstruction
Which of the following proposition(s) is/are
correct?
A) Aortic bioprosthesis Mitroflow need more often a
reintervention
B) Sutureless valves stay in position due to the radial force of
their stent
C) Sutureless valves are implanted through a mini-thoracotomy
D) The Lancelot S valve is a auto-expandable Sutureless aortic
bioprosthesis
E) The CoreValve is less responsible for conductive disorders
after TAVI implantation than the Edward Sapien valves
Which of the following proposition(s) is/are
correct?
A) Aortic bioprosthesis Mitroflow need more often a
reintervention
B) Sutureless valves stay in position due to the radial force of
their stent
C) Sutureless valves are implanted through a mini-thoracotomy
D) The Lancelot S valve is an auto-expandable Sutureless aortic
bioprosthesis
E) The CoreValve is less responsible for conductive disorders
after TAVI implantation than the Edward Sapien valves
Explanations
A) Early structural valve deterioration is frequent in Mitroflow
bioprosthesis (models 12A/LX), especially for small sizes
(19-21 mm), and reduces overall survival (Circulation, 2014)
C) Mini-thoracotomy
D) It’s Perceval !!!
E) Placement of a new permanent pacemaker was less frequent in
the balloon-expandable valve group (Edward Sapien XT) vs selfexpandable valve (Medtronic Corevalve) (P = 0.001)
(The CHOICE Randomized Clinical Trial FREE, M. Abdel-Wahab et al, JAMA 2014;31:1503-1514)
Which of the following proposition(s) about IE
affecting intracardiac prosthetic material is/are
correct?
A) At least 10 positive blood cultures are necessary before starting
antibiotic treatment
B) A TOE is recommended in case of high clinical suspicion whatever
the results of TTE
C) 18F-FDG PET/CT must be considered in case of clinical suspicion
with positive blood culture and negative echocardiography
D) In case of suspicion, the patient’s file must be evaluated by a
multidisciplinary « Endocarditis Team »
E) The Duke criteria are not valid
Which of the following proposition(s) about IE
affecting intracardiac prosthetic material is/are
correct?
A) At least 10 positive blood cultures are necessary before starting
antibiotic treatment
B) A TOE is recommended in case of high clinical suspicion whatever
the results of TTE
C) 18F-FDG PET/CT must be considered in case of clinical suspicion
with positive blood culture and negative echocardiography
D) In case of suspicion, the patient’s file must be evaluated by a
multidisciplinary « Endocarditis Team »
E) The Duke criteria are not valid
A) 3 or more sets of blood cultures are recommended before prompt
initiation of antimicrobial therapy for CIED infection IC
B) TOE is recommended in patients with suspected CDRIE with positive or
negative blood cultures, independant of the results of ETT IC
C) 18F-FDG PET/CT scanning may be considered in patients with suspected
CDRIE, positive blood cultures, and negative echocardiography IIbC
D) Patients with complicated IE should be evaluated and managed at an
early stage in a reference centre, with immediate surgical facilities and the
presence of multidisciplinary « Endocarditis Team » IIaB
E) The Duke Criteria present with lower diagnostic accuracy in PVE.
Which of the following proposition(s) is/are
correct?
A) A TOE should be systematically performed for immediate postoperative care after mitral valve replacement
B) The TTE performed at 8 days after valve surgery should be
considered the reference examination
C) Patients with a bioprosthesic valve should benefit from a close
monitoring after the 6th year following surgery
D) The targeted mean transaortic gradient after aortic valve
replacement with a mechanical prosthesis is 12±7 mmHg
E) After valve replacement with a mechanical prosthesis, patients
should have an hemogram every 3 months to check for hemolysis
Which of the following proposition(s) is/are
correct?
A) A TOE should be systematically performed for immediate postoperative care after mitral valve replacement
B) The TTE performed at 8 days after valve surgery should be
considered the reference examination
C) Patients with a bioprosthesic valve should benefit from a close
monitoring after the 6th year following surgery
D) The targeted mean transaortic gradient after aortic valve
replacement with a mechanical prosthesis is 12±7 mmHg
E) After valve replacement with a mechanical prosthesis, patients
should have an hemogram every 3 months to check for hemolysis
Explanations
A) TOE should not be systematically performed in post operative care,
only in case of abnormal findings on TTE or if suspicion of
complications.
B) The 3-month TTE should be considered the reference
echocardiography.
C) True due to bioprosthesis alterations over time
D) There are no overall targeted transvalvular gradient after surgery
since the gradient depends on the prosthesis size and type.
E) Only if suspicion of anemia, no systematical hemogram surveillance.