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Thrombolytics and left-sided prosthetic valve thrombosis. A case report
Hernández-Vilá1, R F Stainback, P Angelini
1Department of Cardiology, Texas Heart Institute, Houston 77030, USA.
Insights
Thrombolytic therapy, using urokinase, offers a low-mortality alternative for treating left-sided prosthetic valve thrombosis in severe heart failure patients. This approach is safer than surgery for select patients, avoiding risks of large clots or mild symptoms.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Therapeutics
Background:
- Prosthetic valve thrombosis (PVT) is a recognized complication of artificial heart valves.
- Surgical intervention for PVT carries a significant risk of mortality.
- Thrombolysis has emerged as a less invasive therapeutic option for PVT.
Observation:
- Three patients with left-sided PVT and New York Heart Association (NYHA) functional class III or IV symptoms were treated.
- All patients presented with severe symptoms indicative of significant hemodynamic compromise.
- Treatment was administered between 1994 and 1997 at the authors' institution.
Findings:
- Successful treatment of left-sided PVT was achieved in all three patients using urokinase.
- Thrombolytic therapy demonstrated a low mortality rate in this cohort.
- Urokinase effectively resolved PVT in patients with advanced heart failure symptoms.
Implications:
- Thrombolysis is an attractive alternative to valve replacement or thrombectomy for select PVT patients.
- Contraindications for thrombolysis include large thrombi and NYHA functional class I or II symptoms due to increased complication risks.
- Careful patient selection is crucial to balance the benefits of thrombolysis against potential embolic and hemorrhagic complications.
Abstract:
Prosthetic valve thrombosis is a well-known condition. Because surgical treatment of prosthetic valve thrombosis is associated with a high mortality rate, the use of thrombolysis as therapy for this condition has gained popularity in recent years. In this article, we discuss the cases of 3 patients who presented to our institution with left-sided prosthetic valve thrombosis between 1994 and 1997. All 3 patients presented with New York Heart Association functional class III or IV symptoms, and all were successfully treated with urokinase. The use of thrombolytic therapy for left-sided prosthetic valve thrombosis is associated with low mortality rates, and therefore is an attractive alternative to valve replacement or thrombectomy. However, the risk of embolic and hemorrhagic complications precludes the use of thrombolysis in patients with large thrombi and in those with New York Heart Association functional class I and II symptoms; for these patients, the risk associated with thrombolysis exceeds surgical mortality rates.