Prosthetic Valve Dysfunction

Prosthetic valve malfunction is a significant consequence of both mechanical and bioprosthetic heart valves and may result in life-threatening haemodynamic impairment. The common processes include structural valve degeneration, ingrowth of fibrotic pannus, thrombus development, paravalvular leak and prosthetic valve endocarditis, leading to stenosis, regurgitation, or mixed lesions. Patients generally appear with new or worsening dyspnoea, fatigue, decreased exercise capacity, palpitations, angina or overt signs of congestive heart failure.

Any unexplained haemodynamic deterioration in a valve recipient must be considered a potential valve dysfunction unless proven otherwise.

Echocardiography is utilised in conjunction with clinical assessment to determine transvalvular gradients, leaflet motion, degree of regurgitation and presence of masses, with cardiac CT increasingly being used to distinguish pannus from thrombus and guide therapeutic intervention. Management depends on aetiology and severity, ranging from optimisation of anticoagulation or thrombolysis for prosthetic thrombosis to prolonged targeted antibiotics for endocarditis and repeat surgery or transcatheter valve-in-valve implantation for advanced structural degeneration or severe paravalvular leak. Early detection and multidisciplinary heart team decision-making are essential to prevent morbidity and mortality in these high-risk patients.