Recombinant tissue-type plasminogen activator therapy in prosthetic mitral valve thrombosis: assessment by transthoracic and transesophageal echocardiography

Prosthetic cardiac thrombosis is a life-threatening complication that needs prompt diagnosis and therapy. We used recombinant tissue-type plasminogen activator (rT-PA), followed by heparin, in three patients with mitral prosthetic thrombosis, which was evident in two and suspect in one. Transthoraci...

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Bibliographic Details
Published in:International journal of cardiology 1995-03, Vol.48 (3), p.219-224
Main Authors: Losi, Maria Angela, Betocchi, Sandro, Briguori, Carlo, Manganelli, Fiore, Elia, Pietro Paolo, Spampinato, Nicola, Chiariello, Massimo
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Echocardiography
Echocardiography, Doppler
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis - adverse effects
Heparin - therapeutic use
Humans
Male
Medical sciences
Middle Aged
Mitral prosthesis thrombosis
Mitral Valve
Pharmacology. Drug treatments
Thrombolysis
Thrombosis - diagnostic imaging
Thrombosis - drug therapy
Thrombosis - etiology
Tissue Plasminogen Activator - therapeutic use
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Summary:Prosthetic cardiac thrombosis is a life-threatening complication that needs prompt diagnosis and therapy. We used recombinant tissue-type plasminogen activator (rT-PA), followed by heparin, in three patients with mitral prosthetic thrombosis, which was evident in two and suspect in one. Transthoracic and transesophageal echocardiography were employed in the diagnosis of both thrombosis and its resolution. No complications occurred. Immediately after the end of treatment with rT-PA, clinical status and echocardiographic data improved in all cases: transthoracic echocardiography showed the normalization of prosthetic function and transesophageal echocardiography showed resolution of thrombosis. One patient needed reoperation for rethrombosis due to the presence of prosthetic fibrous clot. rT-PA, followed by heparin, led to a good clinical result without bleeding and embolic complications in selected patients with mitral prosthetic thrombosis. Transthoracic and transesophageal echocardiography are complementary diagnostic tools in the diagnosis and management of patients with prosthetic thrombosis.
ISSN:0167-5273
1874-1754
DOI:10.1016/0167-5273(94)02242-B