CARDIOVASCULAR JOURNAL OF AFRICA • SMC-PAFCIC Abstracts October 2022 45 AFRICA The patient received immediate medical treatment focused on rehydration, insulin therapy and correction of acidosis. Temporary endocavitary cardiac pacing was discussed, however, regression of the conductive disorders was noticed during the first hours with return of regular sinus rhythm on ECG (Fig.2). Conclusion: Diabetic ketoacidosis is still a frequent emergency requiring agile diagnostic and therapeutic management. Alteration of consciousness state during DKA is often attributed to cerebral edema, yet it could be related to cerebral hypoperfusion cause by conduction disorder, like sinus arrest in our case. Thus, clinicians should be aware of that presentation and refer to current literature for optimum managment. Submission ID: 1600 PROSTHETIC VALVE THROMBOSIS: A REAL CHALLENGE FOR CAREGIVERS (A CASE SERIES OF 9 PATIENTS) NABAWI HIND, BOUTGOURINE MINA, HAZZAZI IKRAM, ELJAMILI MOHAMED, ELHATTAOUI MUSTAPHA MOROCCO Background: Prosthetic valve thrombosis is a rare but serious complication of valve replacement. It’s a life-threatening complication in the short term. We reviewed its incidence and risk factors essentially in relation with inadequate anticoagulation as well as treatment strategies. Objective: Insist on the key importance of education of patients about anticoagulation. Also, to review the latest guidelines on its management. Methods: Retrospective and descriptive study conducted in the cardiology department of the University Hospital of Marrakech from August 2021 to August 2022 including all patients hospitalized for Prosthetic valve thrombosis. Results: Nine cases were found during the period of the study. Females predominate with a sex ratio of 0.28. The average age was 41 years with extremes ranging from 30 to 60 years. 5 patients had mitral prosthesis and 4 in mitro-aortic position. However, all patients had only mitral thrombosis. Time interval between surgery and thrombosis varies from 2 to 10 years. All patients were poorly compliant with antivitamin K therapy with irregular INR monitoring. All patients were unaware about the seriousness of the situation and were from a disadvantaged background. 3 patients were admitted for dyspnea stage III, 6 for dyspnea stage IV, in addition of syncope in one patient. TTE and TEE showed mitral valve block in all cases with high mean transvalvular gradients. Radiocinema was performed in all patients and confirmed the mitral valve block. Initial treatment was based on UFH with diuretics. Thrombolysis was performed in only one patient due to hemodynamic instability. All the patients underwent prosthetic mitral valve replacement with per operative evidence of obstructive thrombus. Discussion: According to the latest European guidelines, urgent surgery is formally indicated in case of obstructive thrombosis with NYHA class III or IV dyspnea ( I B). Thrombolysis is an alternative treatment to surgery for patients with NYHA class III or IV dyspnea for whom surgery is contraindicated or not available (IIa, B) Conclusion: This study emphasize the need of meticulous surveillance of anticoagulation and most importantly more proactive work on therapeutic education from caregivers to prevent the occurrence of this pathology . Intraoperative evidence of obstructive thrombus in the mitral prosthesis. Radiocinema of a miral prosthesis showing a blocked valvular fin. TEE showing a blocked mitral valve fin. TTE showing a mean trans mitral gradient estimated at 16 mmh. MODERATED POSTER SESSION
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