Prosthetic heart valve trombosis: thrombolytic therapy as first approach

Background and goal of study

Prosthetic heart valve thrombosis (PHVT) after surgical replacement is a threatened complication. The incidence of PHVT may be as high as 13% in the first year or higher if concern to the tricuspid valve. Emergency surgery (thrombectomy or another valve replacement) is the recommended treatment. Thrombolytic therapy has been proposed as an alternative to surgery and is considered the treatment of choice for tricuspid PHVT. Optimal management of patients with PHVT remains controversial.

Materials and methods

Sixty-five consecutive patients (January 1997 and December 2003) met clinical and echocardiographic evidence of prosthetic valve dysfunction (thrombotic). Intravenous recombinant streptokinase (SKr) at a loading dose of 250,000 IU over 30 min followed by an infusion of 100,000 IU/h was infused. Clinical and echocardiography surveillance were conducted in an intensive care unit.

Results and discussion

Sixty (92.3%) patients were succesfully treated. Fifty-six (86.1%) had a total recovery, four (6.1%) had a partial response and treatment failed in five patients (7.6%). Embolic migration occurred in five (7.6%) patients and two patients (3%) died because of it. Three patients (4.6%) had some hemorrhagic disorders.

Conclusions

Thrombolytic therapy is feasible and safe. Surgical treatment is not contraindicated even if thrombolitic therapy partially failed allowing better hemodynamic status after all.