Valvular Prosthesis Dysfunction: A Single-Center Experience of 77 Cases — Clinical, Echocardiographic, and Etiological Profiles

Abstract

Background: Prosthetic valve dysfunction is a clinically important complication of valve replacement, with potentially serious haemodynamic, thromboembolic and infectious consequences. Its assessment requires evaluation of the clinical presentation, prosthetic valve haemodynamics and underlying mechanisms. Objective: To describe the clinical, echocardiographic and aetiological characteristics of patients with prosthetic valve dysfunction managed at Mohammed VI University Hospital Centre, Marrakech. Methods: This retrospective, observational, single-centre study included 77 patients with suspected or confirmed prosthetic valve dysfunction. Clinical characteristics, echocardiographic findings, cinefluoroscopic assessments and aetiological investigations were reviewed using the available hospital records. Results: The mean patient age was 54.1 ± 13.6 years, and 53.2% were women. Most patients were symptomatic, with 62.3% classified as New York Heart Association functional class III–IV. Ischaemic neurological events were documented in 26.0% of patients, while respiratory instability occurred in 14.3%. Transthoracic echocardiography demonstrated satisfactory prosthetic valve opening in 48 patients (62.3%). Left ventricular systolic dysfunction was identified in 23 patients, including eight with severe dysfunction. The mean systolic pulmonary artery pressure was 38.3 ± 10.9 mmHg. Haemolysis was identified in 28 patients (36.4%), prosthetic valve thrombosis in 17 (22.1%), pannus formation in 15 (19.5%) and infective endocarditis in nine (11.7%). Several mechanisms coexisted or remained difficult to differentiate. Conclusion: Prosthetic valve dysfunction demonstrated heterogeneous clinical and aetiological characteristics. An integrated assessment using echocardiography and complementary imaging was important for identifying the underlying mechanisms and informing clinical management.