Valvular Prosthesis Dysfunction: A Single-Center Experience of 77 Cases — Clinical, Echocardiographic, and Etiological Profiles
F. Haffane *
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center (CHU) Marrakech, Cadi Ayyad University, Marrakech, Morocco.
K. Elaakib
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center (CHU) Marrakech, Cadi Ayyad University, Marrakech, Morocco.
S. Oudadda
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center (CHU) Marrakech, Cadi Ayyad University, Marrakech, Morocco.
J. El Masrioui
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center (CHU) Marrakech, Cadi Ayyad University, Marrakech, Morocco.
S. El Karimi
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center (CHU) Marrakech, Cadi Ayyad University, Marrakech, Morocco.
M. El Hattaoui
Department of Cardiology, Faculty of Medicine and Pharmacy, Arrazi Hospital, Mohammed VI University Hospital Center (CHU) Marrakech, Cadi Ayyad University, Marrakech, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Prosthetic valve dysfunction is a clinically important complication of valve replacement, with potentially serious haemodynamic, thromboembolic and infectious consequences. Its assessment requires evaluation of the clinical presentation, prosthetic valve haemodynamics and underlying mechanisms.
Objective: To describe the clinical, echocardiographic and aetiological characteristics of patients with prosthetic valve dysfunction managed at Mohammed VI University Hospital Centre, Marrakech.
Methods: This retrospective, observational, single-centre study included 77 patients with suspected or confirmed prosthetic valve dysfunction. Clinical characteristics, echocardiographic findings, cinefluoroscopic assessments and aetiological investigations were reviewed using the available hospital records.
Results: The mean patient age was 54.1 ± 13.6 years, and 53.2% were women. Most patients were symptomatic, with 62.3% classified as New York Heart Association functional class III–IV. Ischaemic neurological events were documented in 26.0% of patients, while respiratory instability occurred in 14.3%. Transthoracic echocardiography demonstrated satisfactory prosthetic valve opening in 48 patients (62.3%). Left ventricular systolic dysfunction was identified in 23 patients, including eight with severe dysfunction. The mean systolic pulmonary artery pressure was 38.3 ± 10.9 mmHg. Haemolysis was identified in 28 patients (36.4%), prosthetic valve thrombosis in 17 (22.1%), pannus formation in 15 (19.5%) and infective endocarditis in nine (11.7%). Several mechanisms coexisted or remained difficult to differentiate.
Conclusion: Prosthetic valve dysfunction demonstrated heterogeneous clinical and aetiological characteristics. An integrated assessment using echocardiography and complementary imaging was important for identifying the underlying mechanisms and informing clinical management.
Keywords: Valvular prosthesis, prosthetic valve dysfunction, thrombosis, pannus, infective endocarditis, paravalvular leakage, echocardiography, transesophageal echocardiography