Role of thrombolytic therapy for stuck prosthetic valves: a serial echocardiographic study.

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dc.contributor.authorKumar, Sen_US
dc.contributor.authorGarg, Nen_US
dc.contributor.authorTewari, Sen_US
dc.contributor.authorKapoor, Aen_US
dc.contributor.authorGoel, P Ken_US
dc.contributor.authorSinha, Nen_US
dc.date.accessioned2001-07-05en_US
dc.date.accessioned2009-05-27T04:26:37Z
dc.date.available2001-07-05en_US
dc.date.available2009-05-27T04:26:37Z
dc.date.issued2001-07-05en_US
dc.description.abstractBACKGROUND: Thrombotic occlusion of a prosthetic valve continues to be an uncommon but serious complication. Intravenous thrombolytic therapy has been proposed as an alternative to surgical treatment, but only in critically ill patients. METHODS AND RESULTS: Forty-one consecutive patients presenting with 48 episodes of prosthetic valve thrombosis (44 mitral and 4 aortic) were treated with thrombolytic therapy under serial echocardiographic guidance. There were 14 male and 27 female patients. The anticoagulation status was inadequate in 89.6% of episodes. Atrial fibrillation was present in 47.9% of episodes. The prostheses involved in these episodes were tilting disc in 45, bileaflet in 2, and ball and cage type in 1. The Sorin prosthetic valve was the most commonly involved. The time interval between valve replacement and thrombosis ranged from 1 month to 108 months (mean 20.4+/-20.6 months). Patients were in New York Heart Association functional class III in 47.9% and in class II in 43.9% of episodes. Thrombolytic agents used were streptokinase and urokinase in 44 and 4 episodes, respectively. The mean duration of thrombolytic therapy was 27.9+/-15.0 hours and the overall success rate was 87.5%. Patients developed peripheral embolism with almost complete recovery in 5 episodes while significant bleeding that required termination of thrombolytic therapy was observed in 2 episodes. Redo valve replacement was done in 3 episodes because these patients did not improve on thrombolytic therapy (all 3 cases were of recurrent prosthetic valve thrombosis and were found to have pannus peroperatively). Three patients died during thrombolytic therapy because of persistent heart failure. Six patients experienced a total of 13 epidoses of recurrent prosthetic valve thrombosis including index episodes (rethrombosis in 5, re-rethrombosis in 1). They were treated with repeated thrombolysis with a success rate of 76.92%. The mean duration of thrombolytic therapy in these episodes was 36.1+/-14.0 hours. CONCLUSIONS: In patients with prosthetic valve thrombosis, intravenous thrombolysis guided by echocardiography is a safe and effective method that may expand the indications for nonsurgical treatment of prosthetic valve thrombosis. By using serial echocardiography, the duration of thrombolytic therapy can be tailored to the patient's requirement for normalization of valve hemodynamics.en_US
dc.description.affiliationDepartment of Cardiology, Sanjay Gandhi PGIMS, Lucknow, UP.en_US
dc.identifier.citationKumar S, Garg N, Tewari S, Kapoor A, Goel PK, Sinha N. Role of thrombolytic therapy for stuck prosthetic valves: a serial echocardiographic study. Indian Heart Journal. 2001 Jul-Aug; 53(4): 451-7en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/5262
dc.language.isoengen_US
dc.source.urihttps://indianheartjournal.comen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshCoronary Thrombosis --drug therapyen_US
dc.subject.meshEchocardiography, Doppleren_US
dc.subject.meshFemaleen_US
dc.subject.meshGraft Occlusion, Vascular --drug therapyen_US
dc.subject.meshHeart Valve Prosthesisen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPlasminogen Activators --therapeutic useen_US
dc.subject.meshProsthesis Failureen_US
dc.subject.meshStreptokinase --therapeutic useen_US
dc.subject.meshThrombolytic Therapyen_US
dc.subject.meshUrokinase-Type Plasminogen Activator --therapeutic useen_US
dc.titleRole of thrombolytic therapy for stuck prosthetic valves: a serial echocardiographic study.en_US
dc.typeClinical Trialen_US
dc.typeJournal Articleen_US
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