Thrombolytic therapy for a thrombosed Bjork-Shiley tricuspid valve prosthesis
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Thrombolytic therapy with streptokinase successfully treated thrombotic obstruction of a Bjork-Shiley tilting disc tricuspid prosthesis. This treatment improved valve function and cardiac output in a patient with critical stenosis.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Bjork-Shiley tilting disc prostheses are mechanical heart valves used to replace damaged native valves.
- Thrombotic obstruction is a potential complication of mechanical heart valves, leading to stenosis and reduced cardiac function.
- Critical stenosis of a prosthetic valve can cause significant hemodynamic compromise.
Observation:
- A 67-year-old male presented with symptoms of thrombotic obstruction of his tricuspid Bjork-Shiley prosthesis.
- Initial cardiac catheterization revealed critical tricuspid valve stenosis with a significantly reduced cardiac index.
- The patient had a history of mitral and tricuspid Bjork-Shiley tilting disc prostheses implanted 68 months prior.
Findings:
- Intravenous streptokinase infusion for 66 hours was administered.
- Repeat cardiac catheterization demonstrated a 50% reduction in transprosthetic diastolic gradient across the tricuspid valve.
- Prosthetic valve orifice area increased more than fourfold, and the resting cardiac index normalized.
Implications:
- Thrombolytic therapy with streptokinase can be an effective treatment for thrombotic obstruction of Bjork-Shiley tilting disc prostheses.
- Successful treatment restores prosthetic valve function and improves hemodynamic status.
- This case highlights a non-surgical option for managing prosthetic valve thrombosis.
Abstract:
A 67-year-old mand in whom mitral and tricuspid Bjork-Shiley tilting disc prostheses had been implanted 68 months previously presented with thrombotic obstruction of his tricuspid prosthesis. Initial cardiac catheterization demonstrated a significant transprosthetic tricuspid diastolic gradient (9.5 mmHg) with a calculated prosthetic valve orifice area (0.62 cm2) indicating a critical degree of stenosis. The resting cardiac index was markedly reduced (1.5 l/m2/min). Following an intravenous infusion of streptokinase for 66 hours, repeat cardiac catheterization revealed a 50% reduction in transprosthetic diastolic gradient across the tricuspid valve (4.7 mmHg), a greater than fourfold increase in prosthetic valve orifice area (2.87 cm2) with a normal resting cardiac index (3.1 l/m2/min).