[Thrombosis of a Bjork-Shiley mitral valve prosthesis: its thrombolytic treatment with rt-PA]

A 62-year-old woman with a Bjork-Shiley prosthetic mitral valve, presented with pulmonary edema and cardiogenic shock. Doppler echocardiography showed a significant increase of trans-prosthetic gradient due to a thrombotic obstruction. Successful treatment with rt-PA is described. From a subsequent analysis of previous echocardiograms a longstanding asymptomatic thrombus is hypothesised.