Thrombolytic therapy for prosthetic valve thrombosis: a study based on serial Doppler echocardiographic evaluation
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1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
Insights
This study shows that streptokinase effectively treats Björk-Shiley prosthetic valve obstruction, with successful thrombolysis in all patients. Serial Doppler echocardiography is crucial for guiding treatment duration and assessing efficacy.
Area of Science:
- Cardiology
- Medical Devices
- Pharmacology
Background:
- Björk-Shiley prosthetic valve obstruction poses a significant clinical challenge.
- Thrombolytic therapy is a potential treatment option for prosthetic valve thrombosis.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of intravenous streptokinase for Björk-Shiley prosthetic valve obstruction.
- To assess the role of serial echocardiography in guiding thrombolytic therapy.
Main Methods:
- Sixteen patients with obstructed Björk-Shiley valves received intravenous streptokinase.
- Treatment involved an initial bolus followed by continuous infusion.
- Serial echocardiography (M-mode, 2D, Doppler) and cinefluoroscopy were performed throughout treatment.
Main Results:
- Successful thrombolysis was achieved in all 16 patients.
- Average treatment duration was 43 hours.
- 14 of 16 patients showed sustained short-term benefit; two experienced rethrombosis and required thrombectomy.
Conclusions:
- Intravenous streptokinase is a feasible, safe, and effective treatment for Björk-Shiley prosthetic valve thrombosis.
- Serial Doppler echocardiography is essential for optimizing therapy duration and efficacy assessment.
Abstract:
Sixteen patients with echocardiographic and cinefluoroscopic evidence of Björk-Shiley prosthetic valve obstruction (13 mitral valves and 3 aortic valves) were treated with intravenous streptokinase. Streptokinase was administered as an initial bolus of 250,000 units for 30 minutes, followed by an infusion of 100,000 units/hr. Serial cinefluoroscopy and echocardiography (M-mode, two-dimensional, and Doppler) were performed at 0, 24, 48, and 72 hours of treatment. The end point of treatment was defined as near normalization of clinical, echocardiographic, and fluoroscopic parameters. Successful thrombolysis was achieved in all patients. The average duration of streptokinase therapy was 43 hours (range 2 to 72 hours). Two of 16 patients had minor systemic embolism during therapy. Short-term follow-up has shown sustained benefit in 14 of 16 patients. Two patients have had rethrombosis of the mitral prosthetic valves and have undergone thrombectomy. Our study demonstrates the feasibility, safety, and efficacy of thrombolytic therapy in the treatment of prosthetic valve thrombosis. It also emphasizes the role of serial Doppler echocardiography in guiding the duration of therapy and assessing its efficacy.