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Updated: Sep 26, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Acute Mechanical Mitral Valve Thrombosis Treated by Endovascular Recombinant Tissue Plasminogen Activator in a
M de Thomaz de Bossierre1, G de Beco2, A Van Damme3
1Division of Congenital and Pediatric Cardiology, Department of Pediatrics, University Hospitals Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Background:
Mechanical mitral valve thrombosis in early childhood is rare, and its acute management is challenging.
Case Summary:
A 2-year-old girl with Shone complex and multiple prior mitral valvuloplasties developed obstructive thrombosis 20 days after inverted Saint-Jude mechanical valve implantation (mean mitral gradient 26.75 mm Hg). Given multiple previous sternotomies and hemodynamic stability, catheter-directed, continuous low-dose alteplase was infused into the left atrium with a catheter positioned into the left inferior pulmonary vein (0.045 mg/kg/h; then 0.1 mg/kg/h) under uninterrupted heparinization. Leaflet mobility improved within 48 hours, with complete thrombus resolution and no hemorrhagic complications.
Discussion:
This case illustrates that continuous, low-dose local thrombolysis with alteplase may be a safe and effective alternative for mechanical mitral valve thrombosis in pediatric patients, especially those with elevated surgical risks.
Take-Home Message:
Catheter-directed, continuous low-dose alteplase can promptly restore prosthetic mitral valve function in stable pediatric patients, provided strict monitoring and anticoagulation stewardship.
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