CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 7, August 2013
254
AFRICA
in our study.We also defined a statistically significant relationship
between infective endocarditis and perivalvular leak (
p
=
0.043).
As anticipated, infection resulted in structural degeneration and
eventually perivalvular leak. Infective endocarditis also increased
the risk for valvular thrombus. This may have been due to the low
sociocultural status of the patients, and impaired communication
between the patient and treating physician to provide effective
and suitable medical treatment.
There are studies in the literature investigating the role of
MPV in various conditions, such as coronary artery ectasia,
outcome after myocardial infarction, unstable angina, coronary
artery disease in haemodialysis patients, atherosclerosis
and coronary heart diseases.
16-21
MPV was reported to be an
indicator of platelet activation, which resulted in development
of thrombosis. It was found that large platelets contained denser,
more active granules metabolically and enzymatically, with
higher thrombotic potential. Therefore, they secreted more
pro-thrombotic substances, pro-coagulatory surface proteins,
thromboxane A2, serotonin and
β
-thromboglobulin.
Ta
ş
o
ğ
lu
et al
.
22
conducted a study on the predictive marker
value of MPV in patients with mechanical valve thrombosis.
They reported that MPV may be used effectively during follow
up of these patients. Similarly, we determined that MPV values
were higher in patients with valvular thrombus, compared to the
controls. This indicated a statistically significant trend. Based
on the ROC curve, MPV had more than 80% sensitivity and
specificity. However, the small sample size, non-standardised
MPV values before re-operation, absence of detailed genetic
examination, and thrombogenic factors were critical limitations
of our study.
Many studies have been conducted using cheap but effective
markers to identify the relationship between thrombosis and
inflammation. As MPV is believed by some researchers to be a
good candidate, it is being investigated in various cardiac diseases.
MPV is therefore considered an acute-phase reactant and in recent
years has been shown to be raised in inflammatory processes.
23
Bansal
et al
.
24
reported that the incidence of pulmonary embolism
and PHT were higher in patients with chronic obstructive
pulmonary disease and a higher level of MPV.
Conclusion
Morbidity and mortality rates in heart valve re-operations can
be decreased by the effective use of warfarin, the adoption of
minimally invasive surgery, and the use of improved materials
and advanced technology in artificial heart valve production.
Moreover, MPV is an independent risk factor for valvular
thrombus formation. Therefore, MPV values should be assessed
and INR levels should be monitored more often when designing
individualised postoperative medical treatment for patients
undergoing heart valve re-operation.
References
1.
Iung B, Vahanian A. Mitral stenosis.
Ann Cardiol Angeiol
2003;
52
(2):
117–124.
2.
Weerasinghe A, Edwards MB, Taylor KM. First redo heart valve
replacement: a 10-year analysis.
Circulation
1999;
99
(5): 655–658.
3.
Fremes SE, Goldman BS, Ivanov J, Weisel RD, David TE, Salerno T.
Valvular surgery in the elderly.
Circulation
1989;
80
(3 Pt 1): 177–190.
4.
Cohn LH, Aranki SF, Rizzo RJ, Adams DH, Coqswell KA, Kinchla
NM,
et al
. Decrease in operative risk of reoperative valve surgery.
Ann
Thorac Surg
1993;
56
(1): 15–20.
5.
Jones JM, O’kane H, Gladstone DJ, Sarsam MA, Campalani G,
MacGowan SW,
et al.
Repeat heart valve surgery: risk factors for
operative mortality.
J Thorac Cardiovasc Surg
2001;
122
(5): 913–918.
6.
Rizzoli G, Guglielmi C, Toscano G, Pistorio V, Vendramin I, Bottio
T,
et al.
Reoperations for acute prosthetic thrombosis and pannus: an
assessment of rates, relationship and risk.
Eur J Cardiothorac Surg
1999;
16
(1): 74–80.
7.
Toker ME, Eren E, Guler M, Kirali K, Yanartas M, Balkanay M,
et al
.
Second and third cardiac valve reoperations: factors influencing death
and long-term survival.
Tex Heart Inst J
2009;
36
(6): 557–562.
8.
Dasi LP, Simon HA, Sucosky P, Yoganathan AP. Fluid mechanics
of artificial heart valves.
Clin Exp Pharmacol Physiol
2009;
36
(2):
225–237.
9.
Nobili M, Sheriff J, Morbiducci U, Redaelli A, Bluestein D. Platelet
activation due to hemodynamic shear stresses: damage accumulation
model and comparison to
in vitro
measurements.
ASAIO J
2008;
54
(1):
64–72.
10. Sivasubramanian S, Vijayshankar CS, Krishnamurthy SM, Santhosham
R, Dwaraknath V, Rajaram S. Surgical management of prosthetic valve
obstruction with the Sorin tilting disk prosthesis.
J Heart Valve Dis
1996;
5
(5): 548–552.
11. Bollag L, Attenhofer Jost CH, Vogt PR, Linka AZ, Rickli H, Oechslin
E,
et al.
Symptomatic mechanical heart valve thrombosis: high morbid-
ity and mortality despite successful treatment options.
Swiss Med Wkly
2001;
131
(9-10): 109–116.
12. Beghi C, De Cicco G, Nicolini F, Ballore L, Reverberi C, Gherli T.
Cardiac valve reoperations: analysis of operative risk factors in 154
patients.
J Heart Valve Dis
2002;
11
(2): 258–262.
13. De Cicco F, Lorusso R, Colli A, Nicolini F, Fragnito C, Grimaldi T,
Borrello B,
et al
. Aortic valve periprosthetic leakage: anatomic obser-
vations and surgical results.
Ann Thorac Surg
2005;
79
(5): 1480–1485.
14. Thubrikar M, Nolan SP, Bosher LP, Deck JD. The cyclic changes
and structure of the base of the aortic valve.
Am Heart J
1980;
99
(2):
217–224.
15. Potter DD, Sundt TM 3rd, Zehr KJ, Dearani JA, Daly RC, Mullany CJ,
et al
. Risk of repeat mitral valve replacement for failed mitral valve
prostheses.
Ann Thorac Surg
2004;
78
(1): 67–72.
16. Sen N, Tavil Y, Yazici HU, Hizal F, Açikgöz SK, Abaci A,
et al
. Mean
platelet volume in patients with coronary artery ectasia.
Med Sci Monit
2007;
13
: CR356–9.
17. Martin JF, Bath PM, Burr ML. Influence of platelet size on outcome
after myocardial infarction.
Lancet
1991;
338
: 1409–1411.
18. Pizzulli L, Yang A, Martin JF, Lüderitz B. Changes in platelet size and
count in unstable angina compared to stable angina or non-cardiac chest
pain.
Eur Heart J
1998;
19
: 80–84.
19. Henning BF, Zidek W, Linder B, Tepel M. Mean platelet volume and
coronary heart disease in hemodialysis patients
. Kidney Blood Press
Res
2002;
25
: 103–108.
20. Kario K, Matsuo T, Nakao K. Cigarette smoking increases the mean
platelet volume in elderly patients with risk factors for atherosclerosis.
Clin Lab Haem
atol 1992;
14
: 281–287.
21. Trowbridge EA, Martin JF. The platelet volume distribution: a signature
of the prethrombotic state in coronary heart disease?
Thromb Haemost
1987;
58
: 714–717.
22. Ta
ş
o
ğ
lu I, Yalçınkaya A, Ula
ş
MM, Lafçı G, Çiçek OF, Ulus AT,
et
al.
Could mean platelet volume be a predictive marker for mechani-
cal valve thrombosis?
Turkish J Thorac Cardiovasc Surg
2011;
19
(3):
301–304.
23. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet
volume: a link between thrombosis and inflammation?
Curr Pharm Des
2011;
17
(1): 47–58.
24. Bansal R, Gupta HL, Goel A, Yadav M. Association of increased
platelet volume in patients of chronic obstructive pulmonary disease:
Clinical implications
J Ind Acad Clin Med
2002;
3
(2): 169–172.
