Wrong statement about prosthetic valve thrombosis – Cardiology MCQ – Answer

Wrong statement about prosthetic valve thrombosis:

Correct answer (Wrong statement about prosthetic valve thrombosis): a) Risk of thrombosis is more at mitral position than tricuspid position

Risk of prosthetic valve thrombosis is more with right sided valves because of the relatively lower pressure circulation on the right side. Tricuspid valve is the most prone for thrombosis due to slowest velocity of flow across. For the same reason, mitral prosthetic valve is more prone for thrombosis than aortic prosthetic valve.
Reduced leaflet motion of bioprosthetic aortic valves demonstrated by four dimensional (4-D) volume rendered computed tomograms [1] has been considered to be due to subclinical leaflet thrombosis. The abnormality resolved after therapeutic anticoagulation.

Prosthetic valve thrombosis is of course more likely with subtherapeutic anticoagulation. It is also more with certain specific types of valves and in the early period after implantation. Annual incidence vary from 0.1% to 5.7%.
The risk of thrombosis is higher with stented porcine bioprosthetic valve than the stentless bioprosthetic valve. Stentless valves also have better orifice area and lower gradients.

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Reference

1. Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, De Backer O, Asch FM, Ruiz CE, Olsen NT, Trento A, Friedman J, Berman D, Cheng W, Kashif M, Jelnin V, Kliger CA, Guo H, Pichard AD, Weissman NJ, Kapadia S, Manasse E, Bhatt DL, Leon MB, Sondergaard L. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015 Nov 19;373(21):2015-24.