Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: a study using serial transesophageal echocardiography

Özkan, Mehmet; Kaymaz, Ci̇hangi̇r; Kırma, Cevat; Sönmez, Kenan; Özdemir, Nihal; Balkanay, Mehmet; Yakut, Cevat; Deligönül, Ubeydullah

doi:10.1016/s0735-1097(00)00654-9

Cited by 143 publications

(110 citation statements)

References 34 publications

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“…Although in previous studies the duration of symptoms did not appear to influence overall success rate, the majority of cases who favorably responded to T had symptoms duration Ͻ1 month. 4,[5][6][7][8][9] In late PVT, on the contrary, we found a different response to T whether blocked or hypomobile leaflet was concerned. All blocked leaflet failed to respond to T, suggesting , as later confirmed at surgery, pannus formation as the cause of valve dysfunction.…”

Section: Role Of F To Predict T Effectcontrasting

confidence: 55%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] It decreased to 5Ϯ3 mmHg (Pϭ. 000) soon after T and to 4Ϯ2 mmHg (Pϭ0.000 versus baseline, PϭNS versus end of T infusion) at 24 hours.…”

Section: Effects Of T On Pressure Gradient and Opening Angle (Figure 2)mentioning

confidence: 99%

“…These numbers compare favorably with previous studies dealing with similar patientsprostheses subset and definition of success. 4,[5][6][7][8][9][10][11] The success/ complication ratio of T in PVT is affected by several factors: patient selection, type of lytic regimen, time interval between onset of PVT and treatment, and site and type of prosthesis. The role of TEE in selecting patients and, hence, minimizing thromboembolic complications of T is an important although not yet established issue.…”

Section: Outcome Of Lytic Treatmentmentioning

confidence: 99%

“…Each patient received only 1 course of T. It is possible that repeated T treatment would have improved overall rate of success. 5,8 However, our institutional policy is to give a second or third T course only in patients who showed partial result after first treatment.…”

Section: Limitation Of the Studymentioning

confidence: 99%

“…1,4 T has been reported to be an effective alternative treatment option. 4,[5][6][7][8][9][10][11] However, the risk of cerebral embolism for left-sided PVT (5-10% for stroke with 6% death), major bleeding (5%), and recurrence PVT (11%) makes T still a debated issue. This controversy is fuelled by the lack of defined clinical and/or noninvasive variables that can predict T result so as to identify the ideal patient for this treatment.…”

mentioning

confidence: 99%

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Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

et al. 2003

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Background-Thrombolysis (T) is an effective therapy for prosthetic valve thrombosis (PVT). Debate still exists as to which clinical or noninvasive finding best predict the result of T. The aim of the study was to investigate the role of fluoroscopy (F) to predict efficacy of T in pts with mitral PVT. Methods-We evaluated 17 consecutive pts with bileaflet mitral PVT. F criteria for PVT were: abnormal disc motion and calculated opening angle Ͼ25°. T was carried out with tissue-type plasminogen activator (tPA; 100 mg over 3 hours followed by heparin infusion for 24 hours) and was considered successful when normalization of leaflet motion and opening angle occurred. Results were evaluated according to symptom duration (Ͻ21 days, early PVT; Ͼ21 days, late PVT) and to F pattern of PVT (blocked leaflet versus hypomobile leaflet). Results-F showed disc motion alteration in 24 of 34 leaflets: 8 leaflets were blocked, whereas 16 were hypomobile. Early (12.7Ϯ6.1 days, range 3-21) and late (113Ϯ114 days, range 28 -365) PVT was present in 8 and 7 pts, respectively. Thrombolysis was successful in 20 of 24 leaflets. Blocked leaflet fully recovered only in early PVT (nϭ4) pts, whereas they remained blocked in late PVT (nϭ4). On the contrary, in all of the cases with hypomobile leaflet, disc motion normalized regardless duration of symptoms and extent of disc motion reduction. Interestingly, 4 leaflets with late PVT was diagnosed as blocked by trans-thoracic (TTE). F showed a residual disc movement in all: they fully recovered after T. Two pts with late PVT had both leaflets affected (1 blocked ϩ1 hypomobile); although blocked leaflet did not respond to T, the normalization of hypomobile significantly improved clinical condition. Conclusions-F can predict result of T in mitral PVT. PVT with F evidence of hypomobile leaflet always recovers regardless of symptom duration and extent of disc motion reduction, suggesting that the small amount of thrombus needed to interfere with discs motion in bileaflet prostheses remains sensitive to T even after a long time. PVT with F evidence of blocked leaflet has a favorable response to T only in case of early PVT. Late PVT with blocked leaflet does not respond to T, suggesting a larger and stratified thrombus and the coexistence of pannus and, in our series, always required surgery. However, if a hypomobile leaflet coexists, T may be used to restore normal movement of hypomobile leaflet so that to improve patient clinical and hemodynamic condition before operation.

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Section: Role Of F To Predict T Effectcontrasting

confidence: 55%

Section: Effects Of T On Pressure Gradient and Opening Angle (Figure 2)mentioning

confidence: 99%

Section: Outcome Of Lytic Treatmentmentioning

confidence: 99%

Section: Limitation Of the Studymentioning

confidence: 99%

mentioning

confidence: 99%

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Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

et al. 2003

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Successful thrombolysis of a partially obstructed bileaflet prosthetic heart valve in the mitral position

Barbetseas

Vitalis

Vyssoulis

et al. 2003

J of Clinical Ultrasound

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We describe the case of a woman who presented with dyspnea of abrupt onset and who had recently undergone replacement of the mitral valve with a bileaflet mechanical prosthesis. Transthoracic echocardiographic examination with spectral Doppler recording of transvalvular blood flow revealed a velocity spectrum consistent with obstruction. Transesophageal echocardiography demonstrated partial obstruction of the prosthetic valve due to immobilization of 1 hemidisc in the closed position. This immobilization was apparently caused by a small mass whose appearance was consistent with that of a thrombus. The patient was successfully treated by intravenous administration of a thrombolytic agent. This case demonstrates the value of transesophageal echocardiography in the selection of candidates for thrombolytic treatment in cases of thrombosis of a left-sided valve prosthesis.

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Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

Shimbo

Watanabe

Kimura

et al. 2014

J of Clinical Ultrasound

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Real-time three-dimensional transesophageal echocardiography (RT3D-TEE) can provide unique visualization and better understanding of the relationship among cardiac structures. Here, we report the case of an 85-year-old woman with an obstructed mitral prosthetic valve diagnosed promptly by RT3D-TEE, which clearly showed a leaflet stuck in the closed position. The opening and closing angles of the valve leaflets measured by RT3D-TEE were compatible with those measured by fluoroscopy. Moreover, RT3D-TEE revealed, in the ring of the prosthetic valve, thrombi that were not visible on fluoroscopy. RT3D-TEE might be a valuable diagnostic technique for prosthetic mitral valve thrombosis.

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Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: a study using serial transesophageal echocardiography

Abstract: In patients with prosthetic valve thrombosis, intravenous slow infusion thrombolysis given in discrete, successive sessions guided by serial TEE and transthoracic echocardiography can be achieved with a low risk of complications and a high rate of success.

Cited by 143 publications

References 34 publications

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?

Successful thrombolysis of a partially obstructed bileaflet prosthetic heart valve in the mitral position

Obstructed bi‐leaflet prosthetic mitral valve imaging with real‐time three‐dimensional transesophageal echocardiography

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