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The Annals of Thoracic Surgery, Vol 58, 462-470, Copyright © 1994 by The Society of Thoracic Surgeons
NK Reddy, TN Padmanabhan, S Singh, DN Kumar, PR Raju, PV Satyanarayana, DP Rao, P Rajagopal and BS Raju
Thrombolytic therapy is used increasingly for prosthetic valve thrombosis.
Fear of peripheral embolism has limited its use in left- sided valve
occlusions. Thirty-eight patients with prosthetic valve occlusion were
treated with thrombolytic agents on 44 occasions. Duration of thrombolytic
therapy was individualized. Patients were followed up with clinical,
echocardiographic, and cine-fluoroscopic evaluation. Average time from
onset of symptoms to presentation was 9.7 days. The anticoagulation status
was inadequate in 70% of instances. The majority (75%) were in functional
class IV, 8 of them being in shock. Overall success was seen in 88.6%:
immediate complete success in 18 and partial in 21. Nine of those with
partial success had delayed opening of the leaflets. There were nine
instances of rethrombosis and one instance of re-rethrombosis; 6 patients
received repeat thrombolysis with success in 5. Seventy-six percent (29/38)
of the patients were surviving at the time of reporting. In conclusion, the
present study demonstrates the feasibility of thrombolytic therapy for
left-sided prosthetic valve occlusion. Delayed opening is common in
patients with initial partial success. Rethrombosis remains a major
problem.
ARTICLES
Thrombolysis in left-sided prosthetic valve occlusion: immediate and follow-up results
Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, India.
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