Successful Treatment of Severe Mechanical Mitral Valve Thrombosis With Tissue Plasminogen Activator in a 7-Month-Old Infant

Severe thrombosis of a mechanical valve is a rare complication in pediatric patients. Thrombolytic therapy as treatment of mechanical mitral valve thrombosis has rarely been reported in young infants. We report the successful treatment with recombinant tissue-type plasminogen activator of a mechanic...

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Bibliographic Details
Published in:Pediatric cardiology 2013-12, Vol.34 (8), p.1903-1907
Main Authors: Cheung, Eva W., Aponte-Patel, Linda, Bacha, Emile A., Singh, Rakesh K., Rosenzweig, Erika Berman, Sen, Anita I.
Format: Article
Language:English
Subjects:
Blood clot
Cardiac Surgery
Cardiology
Care and treatment
Case Report
Children
Dose-Response Relationship, Drug
Echocardiography
Fibrinolytic Agents - administration & dosage
Follow-Up Studies
Health aspects
Heart Diseases - diagnosis
Heart Diseases - drug therapy
Heart Valve Prosthesis
Humans
Implants, Artificial
Infant
Injections, Intravenous
Male
Medicine
Medicine & Public Health
Mitral Valve - surgery
Mitral Valve Insufficiency - surgery
Pediatrics
Prosthesis
Prosthesis Failure
Pulmonary hypertension
Thrombolytic Therapy - methods
Thrombosis
Thrombosis - diagnosis
Thrombosis - drug therapy
Tissue plasminogen activator
Tissue Plasminogen Activator - administration & dosage
Vascular Surgery
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Description
Summary:Severe thrombosis of a mechanical valve is a rare complication in pediatric patients. Thrombolytic therapy as treatment of mechanical mitral valve thrombosis has rarely been reported in young infants. We report the successful treatment with recombinant tissue-type plasminogen activator of a mechanical mitral valve thrombus in a 7 month-old patient with trisomy 21, complete atrioventricular canal defect and pulmonary hypertension status post complete atrioventricular canal repair and subsequent prosthetic mitral valve replacement. He presented with respiratory decompensation and shock secondary to severe mechanical mitral valve stenosis. Serial echocardiograms showed significant resolution of the thrombus within 18 h of infusion with no major bleeding complications during the treatment course. Although a rare complication of mechanical valve placement in pediatrics, thrombosis of mechanical valves may result in severe hemodynamic and respiratory compromise. This case demonstrates that thrombolytic therapy is a feasible option for the treatment of critical thrombosis in pediatric patients after MVR.
ISSN:0172-0643
1432-1971
DOI:10.1007/s00246-012-0446-x