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Published on: November 28, 2018

Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: a study using serial transesophageal

M Ozkan1, C Kaymaz, C Kirma

  • 1Kosuyolu Heart and Research Hospital, Istanbul, Turkey.

Journal of the American College of Cardiology
|June 7, 2000
PubMed

Insights

Transesophageal echocardiography-guided intravenous thrombolysis for prosthetic valve thrombosis is effective. Serial slow infusions, guided by echocardiography, achieve high success rates with low complication risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Echocardiography

Background:

  • Prosthetic valve thrombosis is a rare but serious complication.
  • Intravenous thrombolysis is a proposed alternative to surgery.

Purpose of the Study:

  • To analyze the efficacy and safety of intravenous thrombolytic treatment guided by transesophageal echocardiography (TEE) for prosthetic valve thrombosis.

Main Methods:

  • 32 symptomatic patients with prosthetic valve thrombosis underwent 54 thrombolytic sessions over four years.
  • Transesophageal echocardiography (TEE) was used for baseline and follow-up assessments (98 total examinations).
  • Streptokinase was the initial agent, with tissue plasminogen activator or urokinase used for recurrent thrombosis.

Main Results:

  • Initial treatment success was 53%, increasing to 88% after repeated sessions guided by TEE.
  • Thrombus characteristics on TEE correlated with treatment response; obstructive thrombi had lower success rates (40%) than nonobstructive ones (75%).
  • Slow infusion (15-24h) demonstrated similar success to rapid infusion (3h) but with fewer major complications.

Conclusions:

  • Intravenous slow infusion thrombolysis guided by serial TEE is a safe and effective treatment for prosthetic valve thrombosis.
  • This approach offers a high success rate with a low risk of complications.
  • Echocardiographic guidance is crucial for optimizing treatment outcomes.
Abstract

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