Thrombolysis in left-sided prosthetic valve occlusion: immediate and follow-up results

Thrombolytic therapy is used increasingly for prosthetic valve thrombosis. Fear of peripheral embolism has limited its use in left-sided valve occlusions. Thirty-eight patients with prosthetic valve occlusion were treated with thrombolytic agents on 44 occasions. Duration of thrombolytic therapy was individualized. Patients were followed up with clinical, echocardiographic, and cine-fluoroscopic evaluation. Average time from onset of symptoms to presentation was 9.7 days. The anticoagulation status was inadequate in 70% of instances. The majority (75%) were in functional class IV, 8 of them being in shock. Overall success was seen in 88.6%: immediate complete success in 18 and partial in 21. Nine of those with partial success had delayed opening of the leaflets. There were nine instances of rethrombosis and one instance of re-rethrombosis; 6 patients received repeat thrombolysis with success in 5. Seventy-six percent (29/38) of the patients were surviving at the time of reporting. In conclusion, the present study demonstrates the feasibility of thrombolytic therapy for left-sided prosthetic valve occlusion. Delayed opening is common in patients with initial partial success. Rethrombosis remains a major problem.