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[Fibrinolysis and thrombosis of mechanical valvular prosthesis: risk stratification by transesophageal

R Roudaut1, S Lafitte, M F Roudaut

  • 1Hôpital cardiologique du Haut-Lévêque, CHU de Bordeaux, 33604 Pessac.

Archives Des Maladies Du Coeur Et Des Vaisseaux
|December 5, 2002
PubMed

Insights

Transesophageal echocardiography aids risk stratification for mechanical heart valve thrombosis. Large, mobile thrombi indicate fibrinolysis is less effective and carries higher risks, suggesting it may be a contraindication.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Fibrinolysis for mechanical heart valve thrombosis remains debated.
  • Transesophageal echocardiography (TEE) is crucial for assessing cardiac structures.

Purpose of the Study:

  • To define the role of TEE in risk stratification for mechanical heart valve thrombosis.
  • To evaluate the effectiveness and safety of fibrinolysis based on TEE findings.

Main Methods:

  • A monocentric study of 49 patients with mechanical heart valve thrombosis treated with fibrinolysis.
  • TEE was performed prior to thrombolysis to characterize thrombus size, mobility, and obstruction.
  • Outcomes (clinical events, fibrinolysis success) were analyzed based on thrombus characteristics.

Main Results:

  • Complete fibrinolysis success was 69.4% overall.
  • Thrombus size significantly impacted success rates (88% for <10 mm vs. 35% for ≥10 mm, p < 0.01).
  • Mobile thrombi were associated with a higher rate of systemic emboli (p < 0.01).

Conclusions:

  • TEE is significant in guiding therapeutic choices for valvular prosthesis thrombosis.
  • Voluminous and mobile thrombi are contraindications for fibrinolysis due to increased risks and lower success rates.

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