Korean J Thorac Cardiovasc Surg.  2002 Nov;35(11):826-830.

Thrombolytic Therapy for Thrombosis of Prosthetic Mitral Valve: A Case Report

• Kang SK
• Kim SW
• Won TH
• Ku KW
• Na MH
• Yu JH
• Lim SP
• Lee Y
• Jeong JO

Abstract

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.

Keyword

Prosthetic valve thrombosis(PVT); Thrombolytic therapy

MeSH Terms

Dyspnea
Emergency Service, Hospital
Hemodynamics
Humans
Intubation
Lung
Male
Middle Aged
Mitral Valve Stenosis
Mitral Valve*
Plasminogen
Respiration, Artificial
Respiratory Sounds
Spouses
Thrombolytic Therapy*
Thrombosis*
Urokinase-Type Plasminogen Activator
Warfarin
Plasminogen
Urokinase-Type Plasminogen Activator
Warfarin