This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tong, A. T. Search for Related Content PubMed PubMed Citation Articles by Tong, A. T.

CLINICAL RESEARCH: ECHOCARDIOGRAPHY

Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry

Ann T. Tong, MD, FACC^*, Raymond Roudaut, MD, Mehmet Özkan, MD, Alex Sagie, MD, Maie S. A. Shahid, MD^||, Sergio C. Pontes, Jr, MD^¶, Francesc Carreras, MD^#, Steven E. Girard, MD, PhD^**, Samir Arnaout, MD, Raymond F. Stainback, MD, FACC, Ravi Thadhani, MD, MPH, William A. Zoghbi, MD, FACC^*,* Prosthetic Valve Thrombolysis-Role of Transesophageal Echocardiography (PRO-TEE) Registry Investigators

^* Baylor College of Medicine, Houston, Texas, USA
Hopital Cardiologique Du Haut Leveque, Pessac, France
Kosuyolu Heart and Research Hospital, Istanbul, Turkey
Rabin Medical Center, Petah-Tikva, Israel
^|| King Faisel Specialist Hospital and Research Center, Riyadh, Saudi Arabia
^¶ Instituto Dante Pazzanes E. de Cardiologia, San Paulo, Brazil
^# Hospital De La Santa Creu I Sant Pau, Barcelona, Spain
^** Mayo Clinic, Rochester, Minnesota, USA
American University of Beirut, Beirut, Lebanon
Texas Heart Institute, Houston, Texas, USA
Massachusetts General Hospital, Boston, Massachusetts, USA

Manuscript received February 19, 2003; revised manuscript received August 4, 2003, accepted August 11, 2003.

^* Reprint requests and correspondence: Dr. William A. Zoghbi, Echocardiography Laboratory, The Methodist DeBakey Heart Center, 6550 Fannin, SM-677, Houston, Texas 77030, USA.
wzoghbi{at}bcm.tmc.edu

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.

Abbreviations and Acronyms   BP = blood pressure   CI = confidence interval   NYHA = New York Heart Association   OR = odds ratio   PVT = prosthetic valve thrombosis   TEE = transesophageal echocardiography

This article has been cited by other articles:

				M. Biteker, N. E. Duran, S. Gunduz, T. Gokdeniz, H. Kaya, A. C. Aykan, and M. Ozkan Thrombolysis of an acute prosthetic mitral valve thrombosis presented with cardiogenic shock under the guidance of continuous transoesophageal monitoring Eur J Echocardiogr, May 1, 2009; 10(3): 468 - 470. [Abstract] [Full Text] [PDF]

				2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]

				D. N. Salem, P. T. O'Gara, C. Madias, and S. G. Pauker Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 593S - 629S. [Abstract] [Full Text] [PDF]

				M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]

				M. Das, D. Twomey, A. A. Khaddour, and J. Dunning Is thrombolysis or surgery the best option for acute prosthetic valve thrombosis? Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 806 - 811. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]

				R. Roudaut, K. Serri, and S. Lafitte Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations Heart, January 1, 2007; 93(1): 137 - 142. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]

				U. Elkayam and F. Bitar Valvular Heart Disease and Pregnancy: Part II: Prosthetic Valves J. Am. Coll. Cardiol., August 2, 2005; 46(3): 403 - 410. [Abstract] [Full Text] [PDF]

				M. Lengyel Thrombolysis should be regarded as first-line therapy for prosthetic valve thrombosis in the absence of contraindications J. Am. Coll. Cardiol., January 18, 2005; 45(2): 325 - 325. [Full Text] [PDF]

				A. T. Tong, R. Roudaut, M. Ozkan, A. Sagie, M. S.A. Shahid, S. C. Pontes Jr, F. Carreras, S. E. Girard, S. Arnaout, R. F. Stainback, et al. Reply J. Am. Coll. Cardiol., January 18, 2005; 45(2): 326 - 326. [Full Text] [PDF]

				S. H. Rahimtoola The year in valvular heart disease J. Am. Coll. Cardiol., January 4, 2005; 45(1): 111 - 122. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al. Highlights of the year in JACC 2004 J. Am. Coll. Cardiol., January 4, 2005; 45(1): 137 - 153. [Full Text] [PDF]

				H.P. Kuhl and P. Hanrath The impact of transesophageal echocardiography on daily clinical practice Eur J Echocardiogr, December 1, 2004; 5(6): 455 - 468. [Abstract] [Full Text] [PDF]