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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.
Texas Heart Institute Journal
|July 9, 1998
Summary
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.