Thrombolysis as first choice therapy in prosthetic heart valve thrombosis. A study of 68 patients.

BACKGROUND AND OBJECTIVES: Valvular thrombosis is a serious complication in patients with prosthetic heart valves. Traditional treatment is emergency surgery, but thrombolysis provides a non invasive alternative. In this paper we evaluate the efficacy and safety of thrombolysis in prosthetic heart valve thrombosis. METHODS: Data of 68 patients diagnosed of prosthetic valve thrombosis, treated at the Institute of Cardiology and Cardiovascular Surgery, Havana during a 6-years period were analyzed. They received thrombolysis with a recombinant streptokinase infusion at 250,000 IU in 30 minutes followed by 100,000 IU/hour during 72 hours or less if the thrombosis resolved before. The evaluation was based on clinical and echocardiographic findings. RESULTS: Affected sites were mitral (50 cases), tricuspid (9), and aortic (9). Mean time of prosthesis implantation was 6.8 years. The presentation form was generally heart failure (NYHA functional class III-IV) in 64 (94.1%) patients. Mean time interval between onset of symptoms and diagnosis was 10.6 days. There was total response to treatment in 58 (85.3%) patients, partial in 4 (5.9%) and failure in 6 (8.8%). Recombinant streptokinase overall dose was 5.1 x 10(6) IU and mean infusion time 50 hours. Major hemorrhagic complications were observed in two patients. Five embolic events occurred during thrombolysis. Four patients died. Rethrombosis was noted in 11 patients; 10 were retreated successfully with thrombolysis. CONCLUSIONS: Thrombolysis with recombinant streptokinase is efficacious and safe for the treatment of prosthetic heart valve thrombosis. It does not contraindicate surgical treatment if there is no total response, because patient goes to surgery in better hemodynamic conditions with lower risk. Nowadays it can be considered as first-line treatment in all patients with prosthetic heart valve thrombosis regardless of functional class unless specific contraindications exist.

Thrombolytic therapy with recombinant streptokinase for prosthetic valve thrombosis.

BACKGROUND: Thrombosis is a serious complication of prosthetic heart valves, and management is often difficult. Thrombolytic therapy is a promising alternative to valve re-operation in the prosthetic valve thrombosis. METHODS: Fifteen consecutive patients with prosthetic heart valve thrombosis (10 mitral, 3 aortic, 2 tricuspid) were treated with intravenous recombinant streptokinase: 250,000 UI given over 30 minutes followed by an infusion an 100,000 UI per hour, always with clinical monitoring and echocardiographic examinations repeated at 24, 48, and 72 hours after starting thrombolytic therapy. Doppler echocardiography was the primary method use for diagnosis and was also used to follow the response to therapy RESULTS: Fibrinolytic treatment was successful in 14 (93.3%) patients. Total response was achieved in 13 (86.6%)patients and partial response in 1 (6.7%) patient; one patient died of ventricular fibrillation. No major hemorrhagic events were observed, peripheral embolism occurred in two cases, and one case of minor peripheral bleeding occurred in another. Some patients experienced fever and chills. CONCLUSIONS: The present study demonstrates the feasibility, safety and efficacy of thrombolytic therapy, which may be considered as first-line therapy for prosthetic heart valve thrombosis.

Trombólisis eficaz en un niño con trombosis de prótesis de St Jude en posición aórtica: reporte de un caso / Efficient thrombolisis in a boy with thrombosis of St. Judes prosthesis in aortic position: a case report

Se presenta un paciente de 13 años, con disfunción de prótesis valvular por trombosis de una prótesis de St. Jude en posición aórtica. Por el alto riesgo quirúrgico, fue sometido a tratamiento trombolítico con Estreptoquinasa Recombinante por vía sistémica, con nuestra metodología de bajas dosis y tiempo más prolongado. El diagnóstico y seguimiento de la terapéutica se realizó por ecocardiografía doppler transtorácico; mediante esta técnica se precisó el éxito de la trombólisis(AU)

Trombólisis eficaz en un niño con trombosis de prótesis de St Jude en posición aórtica: reporte de un caso / Efficient thrombolisis in a boy with thrombosis of St. Jude's prosthesis in aortic position: a case report

Se presenta un paciente de 13 años, con disfunción de prótesis valvular por trombosis de una prótesis de St. Jude en posición aórtica. Por el alto riesgo quirúrgico, fue sometido a tratamiento trombolítico con Estreptoquinasa Recombinante por vía sistémica, con nuestra metodología de bajas dosis y tiempo más prolongado. El diagnóstico y seguimiento de la terapéutica se realizó por ecocardiografía doppler transtorácico; mediante esta técnica se precisó el éxito de la trombólisis