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Thrombolytic treatment for massive thrombosis of prosthetic cardiac valves
F Guerrero López1, G Vázquez Mata, A Reina Toral
1Intensive Care Unit, General Hospital Virgen de las Nieves, Granada, Spain.
Insights
Thrombolytic treatment effectively manages massive thrombosis of prosthetic cardiac valves (TPCV), avoiding emergency surgery. Doppler echocardiography is crucial for diagnosis and monitoring treatment response.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Massive thrombosis of prosthetic cardiac valves (TPCV) poses a significant clinical challenge.
- Emergency surgery for TPCV carries substantial risks.
Purpose of the Study:
- To evaluate the efficacy of thrombolytic treatment as an alternative to emergency surgery for TPCV.
- To establish diagnostic criteria and analyze patient outcomes for TPCV.
Main Methods:
- Retrospective study of 7 patients with 10 episodes of TPCV.
- Diagnosis confirmed by clinical data and Doppler-echocardiography.
- Thrombolytic agents (streptokinase, urokinase, rt-PA) administered.
Main Results:
- All patients showed clinical improvement with reduced sPAP and transprosthetic gradient.
- No emergency surgery was required; 4 patients underwent later surgical intervention.
- Hemorrhagic complications were controlled; no embolic events occurred.
Conclusions:
- Fibrinolytic treatment is the recommended initial approach for massive TPCV.
- Reoperation after partially successful fibrinolysis can be performed at lower risk.
- Doppler echocardiography is essential for TPCV diagnosis and treatment monitoring.
Objective:
To present the efficacy of thrombolytic treatment in place of emergency surgery in massive thrombosis of prosthetic cardiac valves (TPCV), and to set out the diagnostic criteria and the patients' evolution.
Design:
Retrospective study.
Setting:
Coronary Care Unit of a Spanish reference hospital.
Patients:
7 patients admitted into the ICU with 10 episodes of TPCV and with advanced functional class.
Interventions:
The diagnosis of TPCV was arrived at through clinical data and was confirmed by Doppler-echocardiography before treatment. Thrombolytic treatment (streptokinase, urokinase or rt-PA) was used. The analysis of paired samples between the data before and after treatment was used.
Measurements And Results:
All the patients underwent an improvement in their clinical condition. A reduction of sPAP and in the mean transprosthetic gradient and an increase in the effective valvular area was achieved. Four patients needed surgical intervention during their follow-up. No case required emergency surgery. One patient died after surgery and the other 6 patients are alive after follow-up of 6-33 months. With the fibrinolytic treatment hemorrhagic complications were always controlled. None of the treated patients presented embolic complications.
Conclusions:
Fibrinolytic treatment is the recommended initial treatment in cases of massive TPCV. When fibrinolysis is only partially successful, reoperation can be performed at lower risk. Doppler echocardiography is fundamental in the diagnosis of TPCV and in monitoring the response to fibrinolytic treatment.