Obstructive Prosthetic Mitral Valve Thrombosis Successfully Thrombolysed with Low-Dose Ultra-Slow Infusion of Tissue Plasminogen Activator

Abstract

prosthetic valve thrombosis (pVt) is one of the major causes of posthetic heart valve failure. treatment modalities for this rare but life threatening complication include anticoagulation with heparin, thrombolytic therapy (tt) and re-do valve surgery. Guidelines lack definitive class I recommendations due to lack of randomised controlled trials, and usually leave the choice of treatment to the clinician's experience. surgery is suggested as a first line strategy in most situations of left sided PVT; however, tt has been recently used with successful outcomes [1][2][3] . this report describes a patient with giant thrombus located on the prosthetic mitral valve, which was succesfully treated with ultraslow infusion (25 hours) of low dose (25 mg) tissue plasminogen activator (tpA) under the guidance of two-dimensional (2d) and real-time three-dimensional (rt-3d) transesophageal echocardiography (TEE) and fluoroscopy.A 57 year-old woman who had undergone mechanical mitral valve replacement (29 mm sorin) 5 years earlier was admitted

Successful Low-Dose tPA for Mechanical Mitral Valve Thrombosis in a Patient with Postinfarction Contained Left Ventricular Free Wall Rupture

“…Repeat TTE showed a decreased transvalvular gradient and relaxation in the restricted leaflet. She was discharged on oral anticoagulation and did not require surgical intervention [6].…”