Thrombolytic Therapy for Thrombosis of Prosthetic Mitral Valve: A Case Report.
- Author:
Shin Kwang KANG
1
;
Si Wook KIM
;
Tae Hee WON
;
Kwan Woo KU
;
Myung Hoon NA
;
Jae Hyun YU
;
Seung Pyung LIM
;
Young LEE
;
Jin Ok JEONG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungnam National University. Daejeon, Korea. thomasna@cnu.ac.kr
- Publication Type:Case Report
- Keywords:
Prosthetic valve thrombosis(PVT);
Thrombolytic therapy
- MeSH:
Dyspnea;
Emergency Service, Hospital;
Hemodynamics;
Humans;
Intubation;
Lung;
Male;
Middle Aged;
Mitral Valve Stenosis;
Mitral Valve*;
Plasminogen;
Respiration, Artificial;
Respiratory Sounds;
Spouses;
Thrombolytic Therapy*;
Thrombosis*;
Urokinase-Type Plasminogen Activator;
Warfarin
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2002;35(11):826-830
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-X valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.
