Conclusions:
BPVT may occur late after valve implantation and should not be confused
for valve degeneration. BPVT should be suspected in patients with
clinical or echocardiographic evidence of BPV dysfunction, especially
when presenting within five years after valve implantation. Elevated
transvalvular gradients can be the first clue in diagnosing subclinical
BPVT. Anticoagulation should be instituted in hemodynamically stable
patients without contraindications before pursuing repeat valve
replacement. Surgery should be reserved for non-responders to
anticoagulation or patients in whom hemodynamic status precludes further
delay. Although the optimal duration of anticoagulation is not known,
long-term anticoagulation should be considered. In the event of
cessation of oral anticoagulation, antiplatelet therapy and frequent
echocardiographic surveillance can be considered.