Localized left atrial administration of tPA for the treatment of mechanical mitral valve thrombosis

Prosthetic valve thrombosis is a dangerous and unfortunately not uncommon medical situation, often seen as a medical emergency. Patients with previously unseen and more confounding medical problems are presenting, making the decision regarding therapeutic options even more complicated. In this case...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2008-08, Vol.72 (2), p.151-155
Main Authors: Desai, Sapna, Kavinsky, Clifford
Format: Article
Language:English
Subjects:
Cardiac Catheterization
Echocardiography, Transesophageal
Female
Fibrinolytic Agents - administration & dosage
Heart Atria
Heart Valve Prosthesis - adverse effects
Humans
Middle Aged
Mitral Valve - diagnostic imaging
Mitral Valve - surgery
Thrombolytic Therapy - methods
thrombosis
Thrombosis - diagnostic imaging
Thrombosis - drug therapy
Thrombosis - etiology
Tissue Plasminogen Activator - administration & dosage
transeptal cath
valvular heart disease
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Summary:Prosthetic valve thrombosis is a dangerous and unfortunately not uncommon medical situation, often seen as a medical emergency. Patients with previously unseen and more confounding medical problems are presenting, making the decision regarding therapeutic options even more complicated. In this case report, we describe a complicated patient with mechanical mitral valve prosthesis placed secondary to rheumatic heart disease, with multiple co‐morbidities including severe left ventricular dysfunction, permanent artrial fibrillation, left femoral deep vein thrombosis, and non‐sustained ventricular tachycardia, who presented with acute valve thrombosis. The patient' history of hemorrhagic stroke and multiple acute ischemic strokes represented an absolute contraindication to more conventional forms of therapy such as intravenous systemic thrombolytics. In the following case report, we present an unprecedented approach to prosthetic valve thrombosis in this seemingly no‐option patient. © 2008 Wiley‐Liss, Inc.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.21585