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Chest Pain, Heart Diseases & Prosthetic Heart Valves   by Dr. KK Aggarwal

Prosthetic heart valves Follow up as important as surgery itself
Patients undergoing prosthetic Valve Surgery need meticulous follow up in the post-operative period. Thorough understanding of the structure of different prostheses, their thrombogenic potential, durability and hemodynamics is imperative for proper management during this period. The treating cardiologist must be familiar with the use of oral anticoagulants (VKAs), their interactions with diet and different drugs to be able to avoid life threatening complications of over or under coagulation. Similarly, thorough knowledge of echocardiography of the prosthetic valves and the interpretation of the various nuances is absolutely essential in the management of these patients. The utility of clinical examination cannot be undermined for it is the astute clinician who picks up the jaundice arising out of hemolysis due to a paravalvular leak or an obstructive valve in association with abnormal sounds and murmurs. Proper recording of all the findings and comparison with baseline findings is of paramount importance. Special precautions should be observed for these patients during special situations like surgery or pregnancy. There is limited data in special populations like the elderly (>70 years), pregnant women and with low molecular heparins, novel anticoagulants and with newer generation valves.
Stress Echocardiography in Valvular Stenotic Heart Disease
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