fibrin and Mitral-Valve-Insufficiency

We report the early failure of two tissue valves within hours of surgery due to the accumulation of cellular debris in two different institutions in the United Kingdom. The valves were both found at explant to be covered in a cellular material - possibly fibrin. From clinical experience and careful review of the literature we have found no other reports of such early valve failure due to the build up of material on the structure of the valve. This rare occurrence needs to be reported in the literature to forewarn clinicians of an early complication that may not be recognized yet.

Topics: Aged; Aortic Valve Stenosis; Bioprosthesis; Device Removal; Fatal Outcome; Female; Fibrin; Heart Valve Prosthesis; Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Reoperation; Thrombosis; Ventricular Dysfunction, Left

The exact mechanisms for thrombus formation in patients with valvular heart disease have not been clearly defined. Abnormalities in plasma coagulation factors indicative of a prothrombotic state may in part account for the risk of stroke and thromboembolism in such patients. The aim of this study was, therefore, to determine the effects of mitral regurgitation (MR) and aortic stenosis (AS) on plasma fibrinogen or fibrin D-dimer levels as indices of a thrombogenic (or prothrombotic) state. A total of 25 patients with valve disease in sinus rhythm were studied: 12 patients (all women; mean age fifty-five years, sem 3.3) with MR; and 13 patients (7 men, 6 women; mean age fifty-seven years, sem 3.5) with AS were studied. Patients with MR had a median plasma fibrinogen that was significantly elevated when compared with female population values (median difference 0.62 g/L; 95% confidence intervals (CI) 0.27 to 1.05, P = 0.0016). However, these patients had a median plasma fibrin D-dimer that was lower than that for population controls (median difference 21 ng/mL; 95% CI 0 to 38, P = 0.05). Patients with aortic valve disease had a median plasma fibrinogen that was significantly increased when compared with population controls (median difference 0.82 g/L; 95% CI 0.34 to 1.24, P = 0.001). These patients had a plasma fibrin D-dimer level that was similar to population values (median difference 3 ng/mL; 95% CI -25 to 22, P = 0.80). Patients with MR or AS have higher plasma fibrinogen levels when compared with "normal" population values, suggesting possible hemorheologic abnormalities in these patients. Subjects with MR had lower plasma fibrin D-dimer levels, suggesting lesser intravascular clotting, consistent with clinical echocardiographic studies. Subjects with AS had plasma fibrin D-dimer levels similar to the "normal" population values, suggestive of a different pathophysiological mechanism for thromboembolism. These findings add to an improved understanding of the relationship between clinical observations and the significance of plasma fibrinogen and fibrin D-dimer levels in thrombogenesis.

Topics: Aortic Valve Stenosis; Cross-Sectional Studies; Female; Fibrin; Fibrinogen; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Thromboembolism

Eighteen percent of heart specimens with isolated ventricular septal defect also had a floppy mitral valve. There was no statistical difference in the incidence of floppy mitral valve in the three age groups considered (less than 1 year, 1 to 16 years and 17 to 91 years). In no patient was a floppy mitral valve considered to be the cause of death. Complications of floppy mitral valve (ruptured chordae tendineae, bacterial endocarditis, mitral regurgitation and fibrin deposits at the mitral valve-left atrial angle) occurred at approximately the same frequency as that reported in autopsy studies of isolated floppy mitral valve. In the specimens with floppy mitral valve and ventricular septal defect, 63% also had floppiness of the tricuspid valve, 16% of the pulmonary valve and 5% of the aortic valve. The anatomic basis for floppy mitral valve was considered to be spongiosal invasion and disruption of the fibrosa of the valve leaflet. In this study, spongiosal invasion of the fibrosa was fully developed by 3 months of age and there was no evidence that the incidence or severity of spongiosal invasion increased between the ages of 3 months and 88 years. These data suggest that the floppy mitral valve is a congenital lesion that reaches full anatomic expression in infancy. No evidence was found that ventricular septal defect and floppy mitral valve share a common etiology.

Topics: Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; Chordae Tendineae; Endocarditis, Bacterial; Female; Fibrin; Heart Diseases; Heart Septal Defects, Ventricular; Humans; Infant; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Rupture, Spontaneous

Sixteen frame-mounted fascia lata valves removed from the mitral, aortic or--in one patient--pulmonary position have been detailed histologically. These valves had remained in 15 patients (11 men and four women) for periods varying between 10 and 44 months. The reason for the original transplantation was either chronic rheumatic endocarditis or calcific aortic disease. In the mitral position, the leaflet in position nearest the site of the original anterior mitral valve cusp showed the least changes. The remaining two leaflets of the fascia lata valve in the mitral position, as well as those removed from the aortic or pulmonary position, showed more severe changes; these consisted of degeneration of collagen tissue and often a severe decrease of nuclei belonging to the fibroblastic series. These changes, as well as superimposition of fibrin or fibrous tissue, tended to become more pronounced the longer the valve had remained in the patient. Viability studies in valves removed from two patients have also been undertaken showing very greatly reduced activity. The possible causes for valve dysfunction have been reviewed, and the findings in this study suggest that contraction of fibrous tissue, which sandwiches the fascia lata valve cusps, may contribute to failure of satisfactory valve function. It is concluded that fascia lata forms a poor substitute for replacement of diseased cardiac valves.

Topics: Adult; Aortic Valve; Aortic Valve Insufficiency; Cell Nucleus; Collagen; Eosinophils; Fascia; Fascia Lata; Female; Fibrin; Fibroblasts; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Pulmonary Valve; Thymidine; Time Factors; Tissue Survival

Topics: Adolescent; Adult; Animals; Antigens; Aortic Valve; Calcinosis; Collagen; Elastic Tissue; Female; Fibrin; Formaldehyde; Humans; Infections; Male; Microscopy, Electron; Middle Aged; Mitral Valve Insufficiency; Stress, Mechanical; Swine; Thrombosis; Tissue Preservation; Transplantation Immunology; Transplantation, Heterologous

Topics: Aortic Valve; Aortic Valve Insufficiency; Evaluation Studies as Topic; Fascia; Fascia Lata; Fibrin; Follow-Up Studies; Heart Valves; Humans; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Transplantation, Autologous; Tricuspid Valve; Tricuspid Valve Insufficiency

Topics: Adolescent; Adult; Aortic Valve Insufficiency; Biological Assay; Blood Coagulation; Cardiac Surgical Procedures; Child; Child, Preschool; Extracorporeal Circulation; Female; Fibrin; Fibrinolysis; Heart Septal Defects; Hemorrhage; Humans; Male; Middle Aged; Mitral Valve Insufficiency