Unusual presentation of mitral prosthetic heart valve thrombosis managed with low dose tenecteplase infusion

Abstract

A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed echocardiographic evaluation revealed possible prosthetic valve thrombosis, which was confirmed by fluoroscopy. She was thrombolysed with low dose infusion of tenecteplase. Post thrombolysis her symptoms improved, valve mobility was restored, and haemoptysis subsided. Left sided prosthetic valve thrombosis presenting predominantly with haemoptysis is very rare.

Tenecteplase in Acute Stroke: What About the Children?

“…In a case report of an 11-year-old treated with tenecteplase for prosthetic mitral valve thrombosis after failure of heparin, an initial 0.25 mg/ kg dose was discontinued halfway through a 6-hour infusion due to hemoptysis, but a second dose of 0.25 mg/ kg was successful the following day. 14 Additionally, adolescents have been included in studies of tenecteplase use for a variety of nonstroke indications; however, no subgroup analyses of younger patients were reported. [15][16][17]…”