Thrombolytic Therapy with Tissue Plasminogen Activator for the Treatment of Nonstructural Malfunction of Bileaflet Cardiac Valve Prostheses

Abstract

This study was conducted to determine the effect of thrombolytic therapy with tissue plasminogen activator (t-PA) for nonstructural malfunction of bileaflet cardiac valve prostheses. Twenty-seven patients with bileaflet prosthetic valve malfunction diagnosed by a combination of cineradiography and transthoracic echocardiography were treated with the administration of intravenous t-PA. The treatment resulted in complete success in 55.6% (15 of 27), partial success in 22.2% (6 of 27), and no change in 22.2% (6 of 27). In the complete success and partial success groups, the condition of the patients in 85.7% (18 of 21) of the cases improved within 24 h after the administration of t-PA. Six cases in whom thrombolytic therapy was instituted more than 1 month (ranged from 1 to 38 months, mean 14.7 months) after the diagnosis of prosthetic valve malfunction showed significantly less effectiveness of thrombolytic therapy with t-PA. Only one patient (3.7%) had a major complication (thromboembolism) after t-PA treatment. The results suggest that thrombolytic therapy with t-PA in patients with nonstructural malfunction of bileaflet cardiac valve prostheses is effective with low incidence of complication when the treatment is instituted early after the diagnosis.

Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta‐analysis

“…. Forty‐eight studies were included ( n = 2239) (Table ). There were 27 studies or study arms evaluating cohorts of patients that underwent surgery for prosthetic heart valve thrombosis ; mean age 45.2 years, 38.9% were male.…”

“…There were 27 studies or study arms evaluating cohorts of patients that underwent surgery for prosthetic heart valve thrombosis ; mean age 45.2 years, 38.9% were male. There were 26 studies or study arms evaluating cohorts of patients that received thrombolytic therapy ; mean age 43.8 years, 36.3% were male. Analysis of study quality by the Newcastle‐Ottawa Scale varied from 4 to 6 stars (mean 5.5).…”

“…There were 27 studies or study arms evaluating cohorts of patients that underwent surgery for prosthetic heart valve thrombosis [17][18][19][20][21][23][24][25][26][27]30,31,33,35,36,39,42,43,[47][48][49][50]53,55,[57][58][59]; mean age 45.2 years, 38.9% were male. There were 26 studies or study arms evaluating cohorts of patients that received thrombolytic therapy [2,16,19,22,[27][28][29]31,32,34,37,38,40,41,[44][45][46][47]49,51,52,54,56,…”

A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography

“…On the contrary, there has been a conflict between the two guidelines as to the diagnostic size of the total length and the area [1,2]. In addition, thrombolytic therapy for the patients with PVT using urokinase and tissue plasminogen activator requires further clinical experience in Japan [4], and is not considered a treatment covered by the national insurance in Japan. The Japan Stroke Society officially states that recombinant tissue plasminogen activator for patients with hemodialysis should be used with caution.…”

“…Thrombus burden \0.8 cm 2 [2] identified patients at lower risk for complications from thrombolysis. Traditionally, the therapy for left-sided obstructive PVT has been an urgent surgery, and it has been the gold standard because specific treatment strategies for PVT are controversial [3][4][5].…”