Thrombolytic therapy for prosthetic valve thrombosis: a study based on serial Doppler echocardiographic evaluation

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.