7 year old bioprosthetic aortic valve - clot

[dcmccarthy]

Good day,

I have a bioprosthetic heart valve that was placed 7 years ago in April. A few weeks ago I developed a clot that traveled to my eye, and took out my vision for 5mins. I've had a CT angio done and everything looks good. Cardiologist also said my valve sounds like the day it went in. Awaiting an echo, but cardiologist is not expecting anything other than 'normal' from it. This will leave me without a diagnosed cause.

Has anyone had such a thing happen? I hate not having a diagnosis.
I also can't help my mind from going to is this a result of covid vaccine. I'm double vaccinated with pfizer's vaccine and no side effects. Has anyone encountered/heard of vaccine induced clots related to prosthetic heart valves in their travels?

Thanks!!!

 

[pellicle]

Hi and sorry to read of your clot.

I know that blaming vaccine for things is popular (thanks anti-vaxxers) but its just not the low hanging fruit here. The low hanging fruit is that (despite the general views expressed here) people with tissue prosthetics can and do need to transit to being on warfarin exactly for thrombosis issues.

I recommend you examine this talk by Dr Schaff from the Mayo from this time signature on.


I actually recommend you go back to the start of that and look at the other points he raises about the misconceptions of "avoiding warfarin" by picking a tissue valve.

So what I recommend is that you take this idea to both (or either of) your Surgeon or your Cardiologist and say "hey, I've read this and what do you think, what studies can we now do to clarify if this is the case and if I do need to go on warfarin to prevent a fatal (or worse) stroke"

Best Wishes

 

[Art O Ceitinn]

Hi dcmccarthy
I had a mini stroke which caused a temporary lost of some vision in my right eye. I went to my cardiologist and he put me on previscan ( like warfarin). This happened a few weeks before my valve was replaced in 2007. My choice of valve was a St. Jude and of course I still take my daily dose of previsan. My INR target is 3 to 3.5, but I had another mini stoke about 2 years ago, when my INR was 2.4. I am up to date with my covid vaccine with no problems or side effects apart from a little soreness in my arm.

 

[Keithl]

Good day,

I have a bioprosthetic heart valve that was placed 7 years ago in April. A few weeks ago I developed a clot that traveled to my eye, and took out my vision for 5mins. I've had a CT angio done and everything looks good. Cardiologist also said my valve sounds like the day it went in. Awaiting an echo, but cardiologist is not expecting anything other than 'normal' from it. This will leave me without a diagnosed cause.

Has anyone had such a thing happen? I hate not having a diagnosis.
I also can't help my mind from going to is this a result of covid vaccine. I'm double vaccinated with pfizer's vaccine and no side effects. Has anyone encountered/heard of vaccine induced clots related to prosthetic heart valves in their travels?

Thanks!!!

The J&J vaccine is the only one remotely linked to clots. It is also possible you have asymptomatic covid at one point that caused a clot, I believe that was a rare side effect of covid.

 

[vitdoc]

A bio prosthetic valve is not the same as a healthy human valve. There is turbulence and some non bio material . So although infrequent there can be micro embolism. Consider lowish dose aspirin. If episodes like this continue despite ASA then possibly more Anticoagulation. They probably won’t find any large vegetations or clots but it is good that they are looking.
You were fortunate that the blockage was temporarily.

 

[pellicle]

A bio prosthetic valve is not the same as a healthy human valve....

Dang, now I'm going to have to see if there is data around for people with a failing native valve to support them requiring ACT and or antiplatelet

 

[dcmccarthy]

Thank you all for the replies!
I knew going into a bioprosthetic it was not a 100% thing to never need anticoagulation, though the incidence of it is not high. I have been on plavix and aspirin the last 3 weeks and have not had another event since. My echo is in 2 days and seeing my cardiologist right after. In the couple of conversations with him so far, he does not feel this is going to be a continued thing, and I don't need to continue the plavix aspirin regime after the results of my echo are available (and assuming normal). I'll discuss with him again about continuing just aspirin (or both) for some time.

To describe my incident a little more - I didnt lose vision completely in my eye. As in my eye didnt "turn off". I knew it was still there, and it more or less had what looked like a grey blob covering about 75% of it. I could still see through the outter 25% edge. At the time of my incident my resting BP was around 150/95 and my resting heart rate is well into the 90s. Both on the high side. Discussion as well for cardiologist in a few days. My blood test for inflamation (possibly indicating temporal arteritis) came back negative, though from what i've read that test is not 100% accurate. I've also had a temporal headache for weeks.

 

[pellicle]

Thank you all for the replies!

Not being sure of your age, I suggest that makes a significant difference in the choice. The further above 65 one is the less clear are benefits to a mechanical valve.

Best Wishes

 

[pellicle]

BTW some may find this risk calculator interesting. It's tuned for Australian vaccines and transmission rates, but you should be able to get a good idea if you substitute your vaccine case based on similarities.

https://corical.immunisationcoalition.org.au/astrazeneca

 

[dcmccarthy]

Not being sure of your age, I suggest that makes a significant difference in the choice. The further above 65 one is the less clear are benefits to a mechanical valve.

Best Wishes

I am mid 40s now. Had my valve done late 30s.

 

[vitdoc]

I have over the years maybe 4 or 5 episodes of partial visual loss In one eye that was fortunately transient. I have a mechanical aortic St. Jude valve and I take Warfarin. My INR has been OK after the last few. Prior episodes were before I self tested. These are small blockages of branches of the central retinal artery. So now I add a baby aspirin to my regimen when I bicycle since all of these episodes occurred when I bicycled. Since I am a Retinal surgeon I see these things in patients frequently. There is nothing else that acts like this other than retinal artery blockages. Temporal arteritis presents quite differently and is generally seen in the aged population.
Not sure why the cardiologist thinks this is a one off. I think aspirin may be in your future. Plavix probably overkill . Cardiologists love Plavix vitamin P.
Good luck.

 

[Chuck C]

This may be of interest:

" Researchers have now found that about 15 percent of all bioprosthetic aortic heart valve patients develop blood clots on the leaflets affecting valve opening,."

https://www.sciencedaily.com/releases/2015/10/151005151210.htm
Several months back a member posted that his surgeon had suggested that once a valve becomes calcified that it is more likely to, in his words, "throw a clot".

At your young age, it would not be surprising if there is some calcification at this point, 7 years out, that has formed on your bioprosthetic valve. I expect that your medical team will know a lot more once they get the results from your echo.

Hoping that this was an outlier occurence and not something that happens again for you.

Please keep us posted of the findings.

 

[tom in MO]

Clots in the eye can be caused by things other than one's valve. Make sure you get assessed for other causes, however often the cause is unknown. In people with replacement valves, clots are usually blamed on the valve, but people w/o valves get them too.

 

[vitdoc]

Clots in the eye can be caused by things other than one's valve. Make sure you get assessed for other causes, however often the cause is unknown. In people with replacement valves, clots are usually blamed on the valve, but people w/o valves get them too.

That is very true. Things like atrial fibrillation, high cholesterol with carotid plaques and less common things like patent foramen ovale are associated with emboli.
But in an otherwise healthy relatively young patient with a bio prosthetic valve I would put my money on the valve.

 

[AZATADINE]

I know that I'll be on 75mg Aspirin daily for the duration of my own tissue valve.

 

[AZATADINE]

Posted to wrong thread...

 

[pellicle]

But in an otherwise healthy relatively young patient with a bio prosthetic valve I would put my money on the valve.

more so than the vaccine ...

 

[carolinemc]

Good day,

I have a bioprosthetic heart valve that was placed 7 years ago in April. A few weeks ago I developed a clot that traveled to my eye, and took out my vision for 5mins. I've had a CT angio done and everything looks good. Cardiologist also said my valve sounds like the day it went in. Awaiting an echo, but cardiologist is not expecting anything other than 'normal' from it. This will leave me without a diagnosed cause.

Has anyone had such a thing happen? I hate not having a diagnosis.
I also can't help my mind from going to is this a result of covid vaccine. I'm double vaccinated with pfizer's vaccine and no side effects. Has anyone encountered/heard of vaccine induced clots related to prosthetic heart valves in their travels?

Thanks!!!

My eye clot was not caused by vaccines, which I have had all of them since childhood. I was without my Warfarin for three months and also type 2 diabetic, that may have caused it, since strokes are common/uncommon for type 2 diabetics. I am still without good vision in my left eye. No other problems.

 

[Humboldtgrrl]

Good day,

I have a bioprosthetic heart valve that was placed 7 years ago in April. A few weeks ago I developed a clot that traveled to my eye, and took out my vision for 5mins. I've had a CT angio done and everything looks good. Cardiologist also said my valve sounds like the day it went in. Awaiting an echo, but cardiologist is not expecting anything other than 'normal' from it. This will leave me without a diagnosed cause.

Has anyone had such a thing happen? I hate not having a diagnosis.
I also can't help my mind from going to is this a result of covid vaccine. I'm double vaccinated with pfizer's vaccine and no side effects. Has anyone encountered/heard of vaccine induced clots related to prosthetic heart valves in their travels?

Thanks!!!

 

[Humboldtgrrl]

While I am pro-Science & not an anti-vaxxer, the vaccines are correlated with problems for some. This is a recent paper on very rare occular problems. Note that having Covid can also cause similar problems. The odds for a different etiology (such as many brought up by other replies) would be more likely, but it is not impossible for a correlation with a vax or covid. There is a need for more research on all the pandemic complexities. Glad the event was temporary, but always good to learn as much as possible. Rare ocular side effects have been noted after COVID-19 vaccination