Thrombolytic treatment for massive thrombosis of prosthetic cardiac valves.

Abstract

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. Retrospective study. Coronary Care Unit of a Spanish reference hospital. 7 patients admitted into the ICU with 10 episodes of TPCV and with advanced functional class. 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. 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. 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.