Added value of cardiac computed tomog- raphy for evaluation of mechanical aortic valve: emphasis on evaluation of pannus with surgical findings as standard reference. Int J Cardiol. 2016;214:454 60. 8. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 9. Barbetseas J, Nagueh SF, Pitsavos C, et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evalu- ation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998;32:1410 7. 10. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evalu- ation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography s Guidelines and Standards Committee and the Task Force on Prosthetic Valves. Developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975 1014. 11. zkan M, G nd z S, Biteker M, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial. JACC Cardiovasc Imaging. 2013;6:206 16. 12. Such D, Symersky P, Tanis W, et al. Multimodality imaging assessment of prosthetic heart valves. Circ Cardiovasc Imaging. 2015;8:e003703. 1. C ceres-L riga FM, P rez-L pez H, Morlans-Hern ndez K, et al. Throm- bolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients. J Thromb Thrombolysis. 2006;21:185 90. 2. Karthikeyan G, Senguttuvan NB, Joseph J, et al. Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies. Eur Heart J. 2013;34:1557 66. 3. Keuleers S, Herijgers P, Herregods M-C, et al. Comparison of thrombolysis versus surgery as a first line therapy for prosthetic heart valve thrombosis. Am J Cardiol. 2011;107:275 9. 4. Nagy A, D nes M, Lengyel M. Predictors of the outcome of thrombolytic therapy in prosthetic mitral valve thrombosis: a study of 62 events. J Heart Valve Dis. 2009;18:268 75. 5. zkan M, akal B, Karakoyun S, et al. Thrombolytic therapy for the treatment of prosthetic heart valve thrombosis in pregnancy with low- dose, slow infusion of tissue-type plasminogen activator. Circulation. 2013;128:532 40. 6. zkan M, G nd z S, Biteker M, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial. JACC Cardiovasc Imaging. 2013;6:206 16. 7. Roudaut R, Lafitte S, Roudaut M-F, et al. Management of prosthetic heart valve obstruction: fibrinolysis versus surgery. Early results and long-term follow-up in a single-centre study of 263 cases. Arch Cardiovasc Dis. 2009;102:269 77. 8. Tong AT, Roudaut R, Ozkan M, et al. Transesophageal echocardiogra- phy improves risk assessment of thrombolysis of prosthetic valve throm- bosis: results of the international PRO-TEE registry. J Am Coll Cardiol. 2004;43:77 84. 9. Bade AS, Shaikh SSA, Khemani H, et al. Thrombolysis is an effective and safe therapy in stuck mitral valves with delayed presentation as well as hemodynamically unstable patients: a single centre study. Cardiol Res. 2018;9:161 4. 10. Pragt H, van Melle JP, Javadikasgari H, et al. Mechanical valves in the pul- monary position: an international retrospective analysis. J Thorac Cardio- vasc Surg. 2017;154:1371 8.e1. CLINICAL STATEMENTS AND GUIDELINES 11. Taherkhani M, Hashemi SR, Hekmat M, et al. Thrombolytic therapy for right-sided mechanical pulmonic and tricuspid valves: the largest survival analysis to date. Tex Heart Inst J. 2015;42:543 7. 12. Kumar BM, Gnanaraj JP, Swaminathan N, et al. Assessment of hemody- namic and clinical response in thrombolytic therapy for prosthetic valve thrombosis. Indian Heart J. 2017;69:S6. 13. zkan M, G nd z S, G rsoy OM, et al. Ultraslow thrombolytic therapy: a novel strategy in the management of PROsthetic MEchanical valve Throm- bosis and the prEdictors of outcomE: the Ultra-slow PROMETEE trial. Am Heart J. 2015;170:409 18. 14. Roudaut R, Lafitte S, Roudaut M-F, et al. Fibrinolysis of mechanical pros- thetic valve thrombosis: a single-center study of 127 cases. J Am Coll Cardiol. 2003;41:653 8. 11.7. Bioprosthetic Valve Thrombosis 11.7.1. Diagnosis of Bioprosthetic Valve Thrombosis 1. Puri R, Auffret V, Rod s-Cabau J. Bioprosthetic valve thrombosis. J Am Coll Cardiol. 2017;69:2193 211. 2. Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al. Prognosis after aortic valve replacement with a bioprosthesis: predictions based on meta- analysis and microsimulation. Circulation. 2001;103:1535 41. 3. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 4. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 5. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 6. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic chal- lenges and treatment opportunities in bioprosthetic valve thrombosis: les- sons from a case series. Eur J Cardiothorac Surg. 2015;47:725 32. 11.7.2. Medical Therapy 1. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet throm- bosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015 24. 2. Jander N, Kienzle R-P, Kayser G, et al. Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position. Am J Cardiol. 2012;109:257 62. 3. Butnaru A, Shaheen J, Tzivoni D, et al. Diagnosis and treatment of early bioprosthetic malfunction in the mitral valve position due to thrombus formation. Am J Cardiol. 2013;112:1439 44. 4. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic chal- lenges and treatment opportunities in bioprosthetic valve thrombosis: les- sons from a case series. Eur J Cardiothorac Surg. 2015;47:725 32. 5. De Marchena E., Mesa J, Pomenti S, et al. Thrombus formation fol- lowing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2015;8:728 39. 6. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 7. Latib A, Naganuma T, Abdel-Wahab M, et al. Treatment and clinical out- comes of transcatheter heart valve thrombosis. Circ Cardiovasc Interv. 2015;8:e001779. 8. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 11.8. Prosthetic Valve Stenosis 11.8.1. Diagnosis of Prosthetic Valve Stenosis 1. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evalu- ation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography s Guidelines and Standards Committee and the Task Force on Prosthetic Valves. Developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975 1014. 2. Lancellotti P, Pibarot P, Chambers J, et al. Recommendations for the im- aging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:589 90. 3. Puri R, Auffret V, Rod s-Cabau J. Bioprosthetic valve thrombosis. J Am Coll Cardiol. 2017;69:2193 211. 4. Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al. Prognosis after aortic valve replacement with a bioprosthesis: predictions based on meta- analysis and microsimulation. Circulation. 2001;103:1535 41. 5. Dangas GD, Weitz JI, Giustino G, et al. Prosthetic heart valve thrombosis. J Am Coll Cardiol. 2016;68:2670 89. 6. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 7. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 8. Barbetseas J, Nagueh SF, Pitsavos C, et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evalu- ation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol. 1998;32:1410 7. 9. Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of struc- tural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation. 2018;137:388 99. 10. Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034 48. 11. Koene BM, Soliman Hamad MA, Bouma W, et al. Impact of prosthesis- patient mismatch on early and late mortality after aortic valve replace- ment. J Cardiothorac Surg. 2013;8:96. 11.8.2. Intervention for Prosthetic Valve Stenosis 1. Leontyev S, Borger MA, Davierwala P, et al. Redo aortic valve surgery: early and late outcomes. Ann Thorac Surg. 2011;91:1120 6. 2. Kaneko T, Vassileva CM, Englum B, et al. Contemporary outcomes of re- peat aortic valve replacement: a benchmark for transcatheter valve-in- valve procedures. Ann Thorac Surg. 2015;100:1298 304. 3. Jaussaud N, Gariboldi V, Grisoli D, et al. Risk of reoperation for mitral bioprosthesis dysfunction. J Heart Valve Dis. 2012;21:56 60. 4. Dvir D, Webb JG, Bleiziffer S, et al. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014;312:162 70. 5. Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve- in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience. JACC Cardiovasc Interv. 2015;8:1735 44. 6. Makkar RR, Fontana G, Jilaihawi H, et al. Possible subclinical leaflet throm- bosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015 24. 7. Jander N, Kienzle R-P, Kayser G, et al. Usefulness of phenprocoumon for the treatment of obstructing thrombus in bioprostheses in the aortic valve position. Am J Cardiol. 2012;109:257 62. 8. Butnaru A, Shaheen J, Tzivoni D, et al. Diagnosis and treatment of early bioprosthetic malfunction in the mitral valve position due to thrombus formation. Am J Cardiol. 2013;112:1439 44. 9. Pislaru SV, Hussain I, Pellikka PA, et al. Misconceptions, diagnostic chal- lenges and treatment opportunities in bioprosthetic valve thrombosis: les- sons from a case series. Eur J Cardiothorac Surg. 2015;47:725 32. catheter aortic valve replacement. JACC Cardiovasc Interv. 2015;8:728 39. 11. Jose J, Sulimov DS, El-Mawardy M, et al. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: inci- dence, characteristics, and treatment outcomes. JACC Cardiovasc Interv. 2017;10:686 97. 12. Latib A, Naganuma T, Abdel-Wahab M, et al. Treatment and clinical out- comes of transcatheter heart valve thrombosis. Circ Cardiovasc Interv. 2015;8:e001779. 13. Chakravarty T, S ndergaard L, Friedman J, et al. Subclinical leaflet throm- bosis in surgical and transcatheter bioprosthetic aortic valves: an observa- tional study. Lancet. 2017;389:2383 92. 14. Gozdek M, Raffa GM, Suwalski P, et al. Comparative performance of transcatheter aortic valve-in-valve implantation versus conventional surgi- cal redo aortic valve replacement in patients with degenerated aortic valve CLINICAL STATEMENTS AND GUIDELINES bioprostheses: systematic review and meta-analysis. Eur J Cardiothorac Surg. 2018;53:495 504. 15. Takagi H, Hari Y, Kawai N, et al. Meta-analysis of transcatheter aortic valve implantation for bicuspid versus tricuspid aortic valves. J Cardiol. 2019;74:40 8. 16. Kaneko T, Aranki S, Javed Q, et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg. 2014;147:117 26. 17. Petrescu I, Egbe AC, Ionescu F, et al. Long-term outcomes of anticoagula- tion for bioprosthetic valve thrombosis. J Am Coll Cardiol. 2020;75:857 66. 11.9. Prosthetic Valve Regurgitation 1. Dvir D, Bourguignon T, Otto CM, et al. Standardized definition of struc- tural valve degeneration for surgical and transcatheter bioprosthetic aortic valves. Circulation. 2018;137:388 99. 2. Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evalu- ation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography s Guidelines and Standards Committee and the Task Force on Prosthetic Valves. Developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975 1014. 11.9.1. Diagnosis of Prosthetic Valve Regurgitation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography s Guidelines and Standards Committee and the Task Force on Prosthetic Valves. Developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975 1014. 2. Lancellotti P, Pibarot P, Chambers J, et al. Recommendations for the im- aging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:589 90. 3. Zoghbi WA, Asch FM, Bruce C, et al. Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: a report from the American Society of Echocardiography. Developed in col- laboration with the Society for Cardiovascular Angiography and Interven- tions, Japanese Society of Echocardiography, and Society for Cardiovascu- lar Magnetic Resonance. J Am Soc Echocardiogr. 2019;32:431 75. 4. Hascoet S, Smolka G, Bagate F, et al. Multimodality imaging guidance for percutaneous paravalvular leak closure: Insights from the multi-centre FFPP register. Arch Cardiovasc Dis. 2018;111:421 31. 5. Garc a-Fern ndez MA, Cort s M, Garc a-Robles JA, et al. Utility of real- time three-dimensional transesophageal echocardiography in evaluating the success of percutaneous transcatheter closure of mitral paravalvular leaks. J Am Soc Echocardiogr. 2010;23:26 32. 6. Nombela-Franco L, Ribeiro HB, Urena M, et al. Significant mitral regurgita- tion left untreated at the time of aortic valve replacement: a comprehen- sive review of a frequent entity in the transcatheter aortic valve replace- ment era. J Am Coll Cardiol. 2014;63:2643 58. 7. Ruiz CE, Hahn RT, Berrebi A, et al. Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis: an expert state- ment. J Am Coll Cardiol. 2017;69:2067 87. 8. Lang RM, Badano LP, Tsang W, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr. 2012;25:3 46. 9. Ruparelia N, Cao J, Newton JD, et al. Paravalvular leak closure under intracardiac echocardiographic guidance. Catheter Cardiovasc Interv. 2018;91:958 65. 1. Akins CW, Bitondo JM, Hilgenberg AD, et al. Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks. J Heart Valve Dis. 2005;14:792 9. 2. Kaneko T, Vassileva CM, Englum B, et al. Contemporary outcomes of re- peat aortic valve replacement: a benchmark for transcatheter valve-in- valve procedures. Ann Thorac Surg. 2015;100:1298 304. 3. Kaneko T, Aranki S, Javed Q, et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg. 2014;147:117 26. 4. Jaussaud N, Gariboldi V, Grisoli D, et al. Risk of reoperation for mitral bioprosthesis dysfunction. J Heart Valve Dis. 2012;21:56 60. 5. Sorajja P, Cabalka AK, Hagler DJ, et al. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30-day outcomes in 115 patients. Circ Cardiovasc Interv. 2011;4:314 21. 6. Sorajja P, Cabalka AK, Hagler DJ, et al. Long-term follow-up of percuta- neous repair of paravalvular prosthetic regurgitation. J Am Coll Cardiol. 2011;58:2218 24. 7. Alkhouli M, Rihal CS, Zack CJ, et al. Transcatheter and surgical manage- ment of mitral paravalvular leak: long-term outcomes. JACC Cardiovasc Interv. 2017;10:1946 56. 8. Alkhouli M, Zack CJ, Sarraf M, et al. Successful percutaneous mitral para- valvular leak closure is associated with improved midterm survival. Circ Cardiovasc Interv. 2017;10:e005730. 9. 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January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused up- date of the 2014 AHA/ACC/HRS guideline for the management of pa- tients with atrial fibrillation: a report of the American College of Cardiol- ogy/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Developed in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140:e125 51. 13.1.2. Intervention for Women With Native VHD Before and During Pregnancy 13.1.2.1. Pre-Pregnancy Intervention 1. Le niak-Sobelga A, Tracz W, KostKiewicz M, et al. Clinical and echocar- diographic assessment of pregnant women with valvular heart diseases maternal and fetal outcome. Int J Cardiol. 2004;94:15 23. 2. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515 21. 3. Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol. 2001;37:893 9. 4. Barbosa PJ, Lopes AA, Feitosa GS, et al. Prognostic factors of rheumatic mitral stenosis during pregnancy and puerperium. Arq Bras Cardiol. 2000;75:215 24. 5. Bhatla N, Lal S, Behera G, et al. Cardiac disease in pregnancy. Int J Gynae- col Obstet. 2003;82:153 9. 6. Orwat S, Diller G-P, van Hagen IM, et al. Risk of pregnancy in moderate and severe aortic stenosis: from the multinational ROPAC registry. J Am Coll Cardiol. 2016;68:1727 37. 7. Tzemos N, Silversides CK, Colman JM, et al. Late cardiac outcomes af- ter pregnancy in women with congenital aortic stenosis. Am Heart J. 2009;157:474 80. 8. Arias F, Pineda J. Aortic stenosis and pregnancy. J Reprod Med. 1978;20:229 32. 9. Silversides CK, Colman JM, Sermer M, et al. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis. Am J Cardiol. 2003;91:1386 9. 10. Yap S-C, Drenthen W, Pieper PG, et al. Risk of complications dur- ing pregnancy in women with congenital aortic stenosis. Int J Cardiol. 2008;126:240 6. 11. Sugishita Y, Ito I, Kubo T. Pregnancy in cardiac patients: possible influence of volume overload by pregnancy on pulmonary circulation. Jpn Circ J. 1986;50:376 83. 12. Bryg RJ, Gordon PR, Kudesia VS, et al. Effect of pregnancy on pressure gradient in mitral stenosis. Am J Cardiol. 1989;63:384 6. 13. Palacios IF, Sanchez PL, Harrell LC, et al. Which patients benefit from percutaneous mitral balloon valvuloplasty? Prevalvuloplasty and post- valvuloplasty variables that predict long-term outcome. Circulation. 2002;105:1465 71. 14. van Hagen IM, Roos-Hesselink JW, Ruys TPE, et al. Pregnancy in women with a mechanical heart valve: data of the European Society of Cardi- ology Registry of Pregnancy and Cardiac Disease (ROPAC). Circulation. 2015;132:132 42. 15. De Santo LS, Romano G, Della Corte A, et al. Mechanical aortic valve replacement in young women planning on pregnancy: maternal and fetal outcomes under low oral anticoagulation, a pilot observational study on a comprehensive pre-operative counseling protocol. J Am Coll Cardiol. 2012;59:1110 5. 16. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during preg- nancy. Eur Heart J. 2018;39:3165 241. 13.1.2.2. During-Pregnancy Intervention 1. Tzemos N, Silversides CK, Colman JM, et al. Late cardiac outcomes af- ter pregnancy in women with congenital aortic stenosis. Am Heart J. 2009;157:474 80. 2. Banning AP, Pearson JF, Hall RJ. Role of balloon dilatation of the aor- tic valve in pregnant patients with severe aortic stenosis. Br Heart J. 1993;70:544 5. 3. Easterling TR, Chadwick HS, Otto CM, et al. Aortic stenosis in pregnancy. Obstet Gynecol. 1988;72:113 8. 4. Lao TT, Adelman AG, Sermer M, et al. 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Am J Cardiol. 2016;118:1046 52. 2. 