PMID- 35692701
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2516-1571 (Electronic)
IS  - 2096-5303 (Print)
IS  - 2516-1571 (Linking)
VI  - 1
IP  - 3
DP  - 2018 Dec
TI  - Clinical valve thrombosis and subclinical leaflet thrombosis in transcatheter 
      aortic heart valves: clinical manifestations, diagnosis, and treatment.
PG  - 111-117
LID - 10.1093/pcmedi/pby016 [doi]
AB  - During the last decade, transcatheter aortic valve replacement (TAVR) has rapidly 
      expanded as an alternative to surgical aortic valve replacement (SAVR) in 
      patients with symptomatic severe aortic valve stenosis (AS) and increased 
      surgical risk. In TAVR, a bioprosthetic valve is positioned within the stenotic 
      native aortic valve. Although favorable short- and medium-term outcomes have been 
      reported, thrombosis of the transcatheter heart valve (THV) has occurred, with 
      two different entities being described: clinical valve thrombosis and subclinical 
      leaflet thrombosis. In clinical valve thrombosis, an increase in transvalvular 
      gradient appears as a result of obstructive thrombus formation, which eventually 
      leads to symptoms of heart failure. Subclinical leaflet thrombosis is an 
      incidental finding, characterized by a thin layer of thrombus covering the aortic 
      site of the leaflet-called hypo-attenuating leaflet thickening (HALT)-as 
      described on and defined by 4-dimensional computed tomography (4DCT) imaging. 
      This phenomenon may affect motion of the leaflets and is then classified as 
      hypo-attenuation affecting motion (HAM). Even in the case of HAM, the 
      transvalvular pressure gradient remains within the normal range. Clinical valve 
      thrombosis requires treatment, whereas the clinical impact and need for 
      intervention in subclinical leaflet thrombosis is uncertain. Anticoagulant 
      therapy protects against and resolves both clinical valve thrombosis and 
      subclinical leaflet thrombosis, but studies exploring different antithrombotic 
      strategies after TAVR are ongoing. This review summarizes currently available 
      literature within the field of THV thrombosis and provides recommendations for a 
      patient-tailored approach in TAVR patients, although guidelines are still 
      lacking.
CI  - (c) The Author(s) [2018]. Published by Oxford University Press on behalf of West 
      China School of Medicine & West China Hospital of Sichuan University.
FAU - Rosseel, Liesbeth
AU  - Rosseel L
AUID- ORCID: 0000-0002-3940-3072
AD  - The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
FAU - De Backer, Ole
AU  - De Backer O
AD  - The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
FAU - Sondergaard, Lars
AU  - Sondergaard L
AD  - The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20181205
PL  - England
TA  - Precis Clin Med
JT  - Precision clinical medicine
JID - 101739592
PMC - PMC8985807
OTO - NOTNLM
OT  - TAVR
OT  - clinical valve thrombosis
OT  - subclinical leaflet thrombosis
EDAT- 2018/12/01 00:00
MHDA- 2018/12/01 00:01
PMCR- 2018/12/05
CRDT- 2022/06/13 03:02
PHST- 2018/08/30 00:00 [received]
PHST- 2018/10/24 00:00 [revised]
PHST- 2018/11/01 00:00 [accepted]
PHST- 2022/06/13 03:02 [entrez]
PHST- 2018/12/01 00:00 [pubmed]
PHST- 2018/12/01 00:01 [medline]
PHST- 2018/12/05 00:00 [pmc-release]
AID - pby016 [pii]
AID - 10.1093/pcmedi/pby016 [doi]
PST - ppublish
SO  - Precis Clin Med. 2018 Dec;1(3):111-117. doi: 10.1093/pcmedi/pby016. Epub 2018 Dec 
      5.