Management of the patient with a prosthetic heart valve

Pregnancy and cardiac valvular prostheses

Many women who have had cardiac valve replacements have reached or will soon be reaching childbearing age. Pregnancy exposes these women to potential problems resulting from the previous valvuloplasty. The three most common problems in this population--thromboembolism, infective endocarditis, and myocardial decompensation are discussed through a review of current literature. Preventive measures and treatment modalities are presented in order to assist nurses caring for these clients during their pregnancy.

Dental treatment and management of a patient with a prosthetic heart valve

The American Heart Association committee recognizes that their regimens do not cover all situations. Each patient should be evaluated individually. The necessity for parenteral therapy or oral erythromycin to continue for 48 hours after all dental procedures should be reevaluated on a case-by-case basis. On the other hand, if the dental manipulation involves an infected site, perhaps antibiotic therapy should be continued until signs of the inflammation subside. Dentists and physicians must use their clinical judgement in prescribing antibiotics. However, as Kaye proposed, any deviation in prescribing antibiotics should be in the direction of higher doses or more effective antibiotics. In addition, practitioners must provide adequate patient education and follow-up. Unfortunately, a negligent dentist, a physician giving poor or inadequate advice, or a patient not following instructions may turn a simple dental procedure into a life-threatening situation and potential tragedy.

Tissue valve replacement of prosthetic heart valves for thromboembolism

Twenty-five patients who had repeated thromboemboli from a prosthetic mitral valve were treated with reoperation using a tissue valve prosthesis. Reoperation was performed an average of 4.0 years after the original valve replacement in 14 men and 11 women, with an average age of 50 (range 35 to 65) years. A stented allograft was used in the first 7 patients and a porcine xenograft in the last 18 patients. There were one hospital death and two late deaths. With the first prosthetic valve there were 66 documented embolic episodes in 101.5 patient years (0.65 embolus/year). Only four embolic episodes in 67.4 patient years (0.059 embolus/year) occurred after tissue valve replacement (P less than 0.001). These results indicate that in patients with recurrent or severe embolization after prosthetic heart valve replacement, rereplacement with a tissue prosthesis can be safely performed and significantly reduces the likelihood that additional embolic episodes will occur.

Late evaluation of patients undergoing valve replacement with the Björk-Shiley prosthesis

This study analyzes 484 patients who survived mitral, aortic, or mitral and aortic valve replacement using the Björk-Shiley prosthesis from January, 1970, through December 31, 1974. Long-term follow-up of 1 1/2 to 6 1/2 years (mean, 3.67 yr) was done on 435 patients (98.2%). Eighty to 85% of the patients have improved noticeably. Thromboembolic problems occurred in 6.9%, representing 1.5 emboli per 1,000 patient-months. Anticoagulant bleeding problems occurred in 6.4% of the patients; late mortality was 15%. Actuarial survival curves showed patients at risk to 6 years having a 79% chance of survival. The same analysis according to preoperative New York Heart Association Functional Classification showed a striking reduction in survival in class IV patients. The Björk-Shiley prosthesis is a good choice for valve replacement today. Earlier diagnosis and treatment are needed to obtain better long-term survival.