Thrombolysis for Bileaflet Valve Thrombosis.

Matsuyama, Nanritsu; Asada, Kunio; Kondo, Keiichiro; Kodama, Toshihiro; Minohara, S; Hasegawa, Shigeto; Sawada, Yoshihide; Okamoto, Jiro; Kinugasa, Seiji; Okamoto, Ken‐ichi; Sasaki, Satoshi

doi:10.4326/jjcvs.28.39

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“…In particular, reports of thrombolytic therapy in 32 patients with a NYHA functional class of either I or II showed an 88% success rate, 3% major‐stroke rate, and 0% mortality rate whereas the lowest reported surgical mortality rate in similar groups was 5%. Therefore, it has been suggested that thrombolytic therapy can be the first‐line treatment for prosthetic valve malfunction especially in patients without unstable hemodynamics and thromboembolic complications (6,7,16,18–20).…”

Section: Discussionmentioning

confidence: 99%

“…The effect of thrombolytic therapy was classified into 3 groups. The complete success group was defined as patients with improvement in the leaflet motion of less than 20 degrees in the opening angle and of greater than 111 degrees in the closing angle in cineradiography and with an improvement of hemodynamics in Doppler echocardiography (5,6,14).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, recombinant human tissue plasminogen activators (recombinant t-PAs) have been developed as a thrombolytic agent for acute myocardial infarction and acute pulmonary artery embolism as an alternative to urokinase. In recent years, the efficiency of this treatment for thrombosed valves has also been reported (6,7). However, to date, the effects of the agent remain unclear because the number of patients treated with the agent is quite small.…”

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Thrombolytic Therapy with Tissue Plasminogen Activator for the Treatment of Nonstructural Malfunction of Bileaflet Cardiac Valve Prostheses

et al. 2002

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This study was conducted to determine the effect of thrombolytic therapy with tissue plasminogen activator (t-PA) for nonstructural malfunction of bileaflet cardiac valve prostheses. Twenty-seven patients with bileaflet prosthetic valve malfunction diagnosed by a combination of cineradiography and transthoracic echocardiography were treated with the administration of intravenous t-PA. The treatment resulted in complete success in 55.6% (15 of 27), partial success in 22.2% (6 of 27), and no change in 22.2% (6 of 27). In the complete success and partial success groups, the condition of the patients in 85.7% (18 of 21) of the cases improved within 24 h after the administration of t-PA. Six cases in whom thrombolytic therapy was instituted more than 1 month (ranged from 1 to 38 months, mean 14.7 months) after the diagnosis of prosthetic valve malfunction showed significantly less effectiveness of thrombolytic therapy with t-PA. Only one patient (3.7%) had a major complication (thromboembolism) after t-PA treatment. The results suggest that thrombolytic therapy with t-PA in patients with nonstructural malfunction of bileaflet cardiac valve prostheses is effective with low incidence of complication when the treatment is instituted early after the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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