Short-course thrombolysis as the first line of therapy for cardiac valve thrombosis

Manteiga, R; Souto, Juan Carlos; Altés, Albert; Mateo, José; Arı́s, Anna; Domínguez, José Manuel; Borrás, Xavier; Carreras, Francesc; Fontcuberta, Jordi

doi:10.1016/s0022-5223(98)70355-1

Cited by 42 publications

(39 citation statements)

References 24 publications

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“…Although in previous studies the duration of symptoms did not appear to influence overall success rate, the majority of cases who favorably responded to T had symptoms duration Ͻ1 month. 4,[5][6][7][8][9] In late PVT, on the contrary, we found a different response to T whether blocked or hypomobile leaflet was concerned. All blocked leaflet failed to respond to T, suggesting , as later confirmed at surgery, pannus formation as the cause of valve dysfunction.…”

Section: Role Of F To Predict T Effectcontrasting

confidence: 53%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] It decreased to 5Ϯ3 mmHg (Pϭ. 000) soon after T and to 4Ϯ2 mmHg (Pϭ0.000 versus baseline, PϭNS versus end of T infusion) at 24 hours.…”

Section: Effects Of T On Pressure Gradient and Opening Angle (Figure 2)mentioning

confidence: 99%

“…These numbers compare favorably with previous studies dealing with similar patientsprostheses subset and definition of success. 4,[5][6][7][8][9][10][11] The success/ complication ratio of T in PVT is affected by several factors: patient selection, type of lytic regimen, time interval between onset of PVT and treatment, and site and type of prosthesis. The role of TEE in selecting patients and, hence, minimizing thromboembolic complications of T is an important although not yet established issue.…”

Section: Outcome Of Lytic Treatmentmentioning

confidence: 99%

“…1,4 T has been reported to be an effective alternative treatment option. 4,[5][6][7][8][9][10][11] However, the risk of cerebral embolism for left-sided PVT (5-10% for stroke with 6% death), major bleeding (5%), and recurrence PVT (11%) makes T still a debated issue. This controversy is fuelled by the lack of defined clinical and/or noninvasive variables that can predict T result so as to identify the ideal patient for this treatment.…”

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confidence: 99%

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Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

et al. 2003

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Background-Thrombolysis (T) is an effective therapy for prosthetic valve thrombosis (PVT). Debate still exists as to which clinical or noninvasive finding best predict the result of T. The aim of the study was to investigate the role of fluoroscopy (F) to predict efficacy of T in pts with mitral PVT. Methods-We evaluated 17 consecutive pts with bileaflet mitral PVT. F criteria for PVT were: abnormal disc motion and calculated opening angle Ͼ25°. T was carried out with tissue-type plasminogen activator (tPA; 100 mg over 3 hours followed by heparin infusion for 24 hours) and was considered successful when normalization of leaflet motion and opening angle occurred. Results were evaluated according to symptom duration (Ͻ21 days, early PVT; Ͼ21 days, late PVT) and to F pattern of PVT (blocked leaflet versus hypomobile leaflet). Results-F showed disc motion alteration in 24 of 34 leaflets: 8 leaflets were blocked, whereas 16 were hypomobile. Early (12.7Ϯ6.1 days, range 3-21) and late (113Ϯ114 days, range 28 -365) PVT was present in 8 and 7 pts, respectively. Thrombolysis was successful in 20 of 24 leaflets. Blocked leaflet fully recovered only in early PVT (nϭ4) pts, whereas they remained blocked in late PVT (nϭ4). On the contrary, in all of the cases with hypomobile leaflet, disc motion normalized regardless duration of symptoms and extent of disc motion reduction. Interestingly, 4 leaflets with late PVT was diagnosed as blocked by trans-thoracic (TTE). F showed a residual disc movement in all: they fully recovered after T. Two pts with late PVT had both leaflets affected (1 blocked ϩ1 hypomobile); although blocked leaflet did not respond to T, the normalization of hypomobile significantly improved clinical condition. Conclusions-F can predict result of T in mitral PVT. PVT with F evidence of hypomobile leaflet always recovers regardless of symptom duration and extent of disc motion reduction, suggesting that the small amount of thrombus needed to interfere with discs motion in bileaflet prostheses remains sensitive to T even after a long time. PVT with F evidence of blocked leaflet has a favorable response to T only in case of early PVT. Late PVT with blocked leaflet does not respond to T, suggesting a larger and stratified thrombus and the coexistence of pannus and, in our series, always required surgery. However, if a hypomobile leaflet coexists, T may be used to restore normal movement of hypomobile leaflet so that to improve patient clinical and hemodynamic condition before operation.

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Section: Role Of F To Predict T Effectcontrasting

confidence: 53%

Section: Effects Of T On Pressure Gradient and Opening Angle (Figure 2)mentioning

confidence: 99%

Section: Outcome Of Lytic Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

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Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

et al. 2003

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“…As we said above, our detailed literature search found that the largest case series included only 6 patients 8 for the treatment of mechanical TV thrombosis and 3 patients for the treatment of PV thrombosis. 10 Thrombolytic therapy seems to be safe and effective in treating right-sided mechanical valve thrombosis. Mild pulmonary embolization after thrombolysis is usually well tolerated and is less serious than embolization into the systemic circulation.…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date

Taherkhani¹,

Hashemi²,

Hekmat³

et al. 2015

Texas Heart Institute Journal

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Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis. We identified 16 patients aged 8–67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival rate of 87.5%. The one-year survival rate for mechanical valve thrombosis treated with thrombolytic therapy (whether pulmonary or tricuspid) was 87.5%. On the basis of our data, we recommend that thrombolytic therapy remain the first-line therapy for right-sided mechanical valve thrombosis in adults or children—including children with complex congenital heart disease and patients with mechanical pulmonary valve thrombosis. Surgery should be reserved for patients in whom this treatment fails.

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Valvular Operations

Chen

Lee

Cohn

2009

Complications in Cardiothoracic Surgery

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Short-course thrombolysis as the first line of therapy for cardiac valve thrombosis

Abstract: A short-course of thrombolytic therapy may be considered first-line therapy for prosthetic heart valve thrombosis. The risk of peripheral embolism may be evaluated for the presence of atrial thrombus by transesophageal echocardiography at diagnosis.

Cited by 42 publications

References 24 publications

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date

Valvular Operations

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