Complications
In severe cases where right-sided heart failure has occurred, diuretics may be used. Decision to use a diuretic would depend on the clinical condition of the patient, and the choice of diuretic should be individualized by the treating specialist. When the condition is severe, patients may not tolerate any diuretics. Further information on treatment of heart failure is available in the topics on heart failure.
Longstanding pulmonary regurgitation can lead to severe right ventricular (RV) dilation and diminished RV systolic performance, which can lead to an inadequate ability to augment cardiac output with exercise and, in some cases, result in heart failure with reduced ejection fraction.
Patient needs to be re-evaluated and consideration given to repeat valve replacement.
All patients with prosthetic valves need antibiotics for prophylaxis against infective endocarditis when undergoing dental procedures that involve manipulation of either gingival tissue or the periapical region of teeth, or perforation of the oral mucosa.[14]
In general, all patients who receive a mechanical valve require lifelong anticoagulation. INR should be monitored and kept between 2.5 and 3.5. Frequency of monitoring should be individualized according to the patient's need and response.
Early mortality for isolated pulmonary valve replacement is 1% in children, and freedom from reoperation for bioprosthetic valve deterioration is approximately 90% at 10 years.[27] In patients with transcatheter pulmonary valve replacement, mortality, and reintervention at 8 years was 8.9% and 25.1% respectively.[29] Patients with mechanical pulmonary valve should be monitored for bleeding complications with warfarin.
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