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An Uncommon Case of Bioprosthetic Mitral Valve Thrombosis Complicated by Intracerebral Haemorrhage
Shariff Raja Ezman Raja,Khir Rizmy Najme,Zainal Abidin Hafisyatul Aiza,Kasim Sazzli 아시아심장혈관영상의학회 2021 Cardiovascular Imaging Asia Vol.5 No.2
An 82-year-old man presented with bioprosthetic valve thrombosis (BVT) following a cardioembolic stroke due to mitral valve infective endocarditis. The patient had previously undergone bioprosthetic mitral valve replacement. After being discharged postoperatively, he represented with weakness due to a novel left-sided stroke and right-sided occipital intracerebral haemorrhage. Both transthoracic and transoesophageal echocardiography revealed BVT on the anterior portion of the prosthesis. Following a multi-disciplinary team discussion, it was agreed that thrombolytics and anticoagulation would be detrimental. The patient continued to worsen and eventually succumbed to congestive cardiac failure. BVT is uncommon, and patients often present with signs and symptoms of heart failure, shock, or embolism. There are no guidelines available for managing BVT in patients with concurrent intracerebral haemorrhage, which highlights the importance of multi-disciplinary decision-making.
Raja Ezman Faridz Raja Shariff,Khairul Shafiq Ibrahim,Hafisyatul Aiza Zainal Abidin,Sazzli Kasim 아시아심장혈관영상의학회 2021 Cardiovascular Imaging Asia Vol.5 No.4
Objective: Little is known regarding the levels of knowledge and attitudes amongst non-cardiology clinicians in managing valvular heart diseasel (VHD). Materials and Methods: To determine the knowledge and attitudes towards management of VHD patients amongst internal medicine clinicians in Malaysia. We conducted a 20-item survey study, distributed amongst internal medicine clinicians. Results: A total of 75 responses was obtained. Respondents included medical officers (50.7%), consultants (32.0%), and pre-consultant specialist (17.3%). Respondents were comfortable using online resources from both formal (94.7%) and informal (74.7%) sources. A large proportion felt that they had ‘insufficient’ or ‘very insufficient’ knowledge and experience managing VHD patients (36.0%), and less than half felt that management of VHD patients within their institutions was ‘adequate’ or ‘very adequate’ (49.4%). Although many were felt to be overzealous with echocardiography monitoring in mild VHD (55.9% felt that it was required within 2 years), nevertheless attitudes regarding referrals to cardiology services for consult and intervention were felt to be appropriate. Conclusion: The survey highlights the need for education amongst internal medicine clinician to tackle both the overzealous attitude in monitoring patients with mild valvular disease on one extreme and in improving early referrals for VHD indicated for intervention on the other.