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Objective Prosthetic valve thrombosis (PVT) is a dreadful complication of mechanical prosthetic valves. Thrombolytic therapy (TT) for PVT is an alternative to surgery and currently making a leading role. This study compares TT with tenecteplase (TNK) and streptokinase (SK) head to head in patients with mitral PVT. Methods In this single center, observational study, patients with mitral PVT diagnosed by clinical data, transthoracic echocardiography, transesophageal echocardiography, and fluoroscopy were included. After excluding patients with contraindications for thrombolysis, they were randomly assigned to receive either SK or TNK regimen. Patients were monitored for success or failure of TT and for any complications. Results Among 52 episodes (47 patients with 5 recurrences) of mechanical mitral PVT, 40 patients were thrombolyzed with SK and 12 patients were thrombolyzed with TNK. Baseline characteristics including demographic profile, clinical and echocardiographic features, and valve types were not statistically significant between the groups. Complete success rate was 77.5% in SK group and 75% in TNK group (p = 0.88). Partial success rate, failure rate, and major complications were not statistically significant between the two groups. Within 12 h of therapy, TNK showed complete success in 33.3% of patients compared to 15% in SK group (p-value <0.02). Minor bleeding was more common in TNK group. Conclusion Slow infusion of TNK is equally efficacious but more effective than SK in the management of mitral mechanical PVT. 75% to 77.5% of PVT patients completely recovered from TT and it should be the first line therapy where the immediate surgical options were remote.
RESUMO
BACKGROUND: Cardiovascular disease still remains the leading cause of death in women. The clinical and angiographic profiles of women undergoing CAG must be clearly understood. However there is not much data regarding the angiographic pattern of CAD in women undergoing CAG. AIM: Our aim was to study the angiographic pattern of coronary artery disease in women undergoing coronary angiogram in our institute. METHODS: The records of 275 consecutive female patients who underwent CAG in our institute from December 2017 to May 2018 were retrospectively analysed. The clinical and angiographic data were taken for detailed analysis from CAG reports and discharge summaries. Baseline characteristics of patients were noted. Angiographic pattern was analysed. All statistical analysis was performed using SPSS17 software. Ap-value <0.05 was considered statistically significant. RESULTS: In our study group, LAD was the most commonly involved vessel, followed by RCA and LCX respectively.26.91% had normal epicardial coronaries. 9.82% had minimal CAD. 28% had SVD;16.36% had DVD; 15.63% had TVD;21.8% had branch vessel disease. In our study, 7.63% had LMD.1.82% had coronary artery anomalies in the form of abnormal origin. In our study, the prevalence of multi vessel disease (DVD and TVD) is 32% among women undergoing CAG. CONCLUSION: There is a significant increase in the number of women diagnosed to have CAD. Understanding the angiographic pattern of CAD in women will give further insight towards aggressive coronary interventions in women.