Fibrinolytic treatment of thrombus on prosthetic heart valves.

Abstract

Fibrinolytic agents were administered for 13 episodes of thrombus formation on mitral or aortic valvar prostheses in 12 patients. The most common presenting features were pulmonary oedema (six cases) or arterial emboli (six cases). The diagnosis of thrombus formation was made by phonocardiography on the following criteria: (a) modifications of the prosthetic sounds (12 cases), (b) appearance of a valvar obstructive syndrome (10 cases). The treatment consisted of streptokinase (100 000 units/h after a loading dose, seven cases) or urokinase using either low doses (75 000 or 112 500 units/h, three cases) or moderate doses (150 000 units/h, three cases) for one to four days. Immediate complete regression of clinical and phonocardiographic anomalies was seen in eight cases. Incomplete improvement was seen in two patients, leading to operation: this was unsuccessful in one patient who had surgery on the third day, and was successful in the other on the 75th day. There were three failures leading to successful reoperative procedures in two patients and to an early death in the third patient suffering from acute myocardial infarction. One non-fatal haemopericardium was observed in a patient treated with streptokinase. No important side effect was noted during delivery in a pregnant woman. During subsequent follow-up, a recurrent episode of thrombus formation was observed in one patient, treated by fibrinolytic therapy with success. One patient had an operation for a valve replacement six months after fibrinolytic treatment because of non-thrombotic valvar dysfunction; the outcome was fatal. Six patients are alive and in good condition, with a follow-up of six months to five years.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…In adults, success is ≈75% with a 25% rate of complications such as bleeding, systemic thromboembolism, failure resulting in reoperation, and death. 335,336,[341][342][343][344][345][346] There is experience with thrombolytic therapy in children for thrombotic occlusion of prosthetic valves, and the results seem similar to the adult experience. 51a,345,347-351 The management of pediatric patients with valve thrombosis should mirror that outlined for adults in the ACC/AHA guidelines for management of patients with valvular heart disease and the eighth edition of the American College of Chest Physicians evidence-based clinical practice guidelines.…”

Acute Thromboses of Disc Valve Prostheses: Fibrinolytic Treatment – Diagnosis

“…This risk is fairly limited. 2 out of 13 cases for Witchitz et al [24]; 5 out of 28 cases in our study. These complications regressed with continuation of the fibrino lytic treatment or after surgical femoral disobstruction (1 case).…”

“…The first cases of fibrinolytic treatment for acute thrombosis of valve prostheses were reported in 1971 and 1977 on valves in the tricuspid position [22,23], In 1980, Witchitz et al [24] reported a series of 13 consecutive cases of thrombosed mitral and aortic valves with a 70% success rate.…”

Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results

“…Some authors have indicated fibrinolytic therapy only for critically ill patients, in NYHA functional class III or IV, in whom the surgical intervention is of high risk, or in patients with contraindications [8][9][10][11][12] . The controversy in regard to the use of fibrinolytic therapy in patients in functional class I or II is based on the low surgical risk observed in this group of patients as compared with the thromboembolic risk caused by fibrinolysis, which ranges from 12 to 17% [10][11][12][13] . On the other hand, some authors have indicated fibrinolysis as the first line of therapy in patients with St. Jude prostheses with a low risk of permanent complications and an excellent chance of success In our study, we selected the stable patients or those with elevated surgical risk due to antecedents of 1 or more previous surgeries, or patients, who, due to some reason, had their anticoagulation temporarily suspended or poorly controlled, ie, who had a transient reason for having a prosthetic thrombosis.…”