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Dual mechanical valve thrombosis resolution through thrombolytics: a case series
Colin McGuire1, Michael Yang2, Alexander Papolos2,3
1Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
European Heart Journal. Case Reports
|September 6, 2023
Summary
Dual prosthetic valve thrombosis (PVT) in high-risk patients can be effectively managed with low-dose thrombolysis. This approach led to leaflet mobility and improved heart failure symptoms in two cases.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Prosthetic valve thrombosis (PVT) is a serious complication of mechanical heart valve replacement.
- Simultaneous thrombosis of multiple prosthetic valves is rare and associated with poor outcomes.
- Limited evidence exists for optimal thrombolysis dosing, timing, and duration in dual PVT.
Observation:
- Two patients with concomitant aortic and mitral PVT presented with severe heart failure (NYHA Class III-IV).
- Both patients had high bleeding risk and presented challenges for surgical intervention.
- Patients received a combination of low-dose, slow, or ultra-slow infusions of tissue plasminogen activator.
Findings:
- Successful resolution of dual PVT was confirmed by cine-fluoroscopy showing freely moving mechanical leaflets.
- Patients experienced significant improvement in heart failure symptoms, returning to NYHA Class II or lower.
- Low-dose thrombolytics with slow infusion may be a safe and effective strategy for multi-valve PVT in high-risk patients.
Implications:
- Multi-disciplinary evaluation is crucial for managing complex PVT cases.
- Pharmacologic thrombolysis, particularly low-dose slow infusion, can be a viable first-line treatment for dual PVT in patients with high bleeding risk and heart failure.
- Further research is needed to establish definitive guidelines for thrombolysis in multi-valve PVT.
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