To investigate the association of FVL, prothrombin G20210A and MTHFR C677T mutations in patients with thrombosed Prosthetic Heart Valves and intracardiac clots.
Blood from consenting healthy donors serving as the Control population (610 males and 111 females) and thirty one (31)patients with thrombosed PHV, left ventricular clot and left Atrial clot was collected. The DNA was extracted and stored at -70°C until needed . Testing for the mutations was done by the Polymerase Chain reaction using restriction enzymes and by the Roche Light Cycler.
Nine subjects from the Control population tested positive for FVL (1.25%); two for prothrombin G20210A (0.28%); and 180 (25.4%) for MTHFR C677T. Thirty-one patients were tested.Twenty-four with thrombosed PHV, five with left ventricular clot and two with left atrial clot. Two patients tested positive for FVL (6.4%), one for prothrombin G20210A (3.2%) and twelve for MTHFR C 677T (38.7%) mutations.
Our data suggest an association between FVL, prothrombin G20210A and MTHFR C677T mutations in patients with thrombosed PHV and intracardiac clots. However, upon comparing the patient population to the normal population no significant difference was found for FVL(P Value= 0.11)and no significant difference for prothrombin G20210A (P value = 0.27) whereas for MTHFR C677T the difference was significant(P value =<0.01). More data is needed to confirm this observation.
Valve thrombosis and systemic thromboembolism continue to be the most serious complication in patients with prosthetic heart valve (PHV) on long-term anticoagulation therapy. While under treatment with oral anticoagulants is a recognized cause for these complication, other factors possibly play a role as not all patients under-treated develop a coagulation problem.Factor V Leiden (FVL) prothrombin G20210A and the 5,10-methylenterahydrofolate-reductase (MTHFR)C677T mutations have been associated with venous & possibly arterial thrombosis. No studies as to whether or not these factors are associated with valve thrombosis or intracardiac clots in patients with PHV are available to date.
Jalal Saour, None.