What are the complications of prosthetic valves ? • Thromboembolism. • Valve dysfunction, including valve leakage, valve dehiscence and valve obstruc-tion due to thrombosis and clogging. Perivalvular leak is always abnormal. 'Built-in' transvalvular leakage should be less than 10 mi per beat. The loss of expected valve sounds is an important sign of mechanical valve thrombosis. • Bleeding (such as upper gastrointestinal haemorrhage) due to anticoagulants. • Haemolysis at the valve, causing anaemia. • Endocarditis, which carries a mortality rate of up to 60%; patients should be urgently referred to a tertiary cardiothoracic centre (see pp 57-60). • Structural dysfunction: fracture, poppet escape, cuspal tear, calcification. • Non-structural dysfunction: paravalvular leak, suture/tissue entrapment, noise.
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