title: Fibrinolytic treatment of acute prosthetic heart valve thrombosis. 5 cases and a review.
abstract: Acute thrombotic obstruction of prosthetic heart valves has usually needed an emergency operation and carries a high mortality. Over the past 16 years, sporadic papers have appeared reporting the successful use of fibrinolytic therapy with a low mortality. We report five consecutive cases treated in this way. The diagnosis of valve thrombosis was made on clinical, echocardiographic and cineradiographic grounds. Treatment consisted of streptokinase (SPK) in a loading dose of 250,000 units in one case and 500,000 units in the remaining four cases, followed by 100,000 units hourly. Rapid improvement in clinical state was seen in all five patients. Four patients recovered completely and have been followed up for a minimum of 3 years. One patient died of a retroperitoneal haemorrhage, a recognised complication of fibrinolytic therapy. A review of the literature is presented. Fibrinolytic therapy is recommended in the acute episode and should result in either a return to normal valve function or sufficient improvement in haemodynamics to allow semielective surgery at considerably lower risk.
authors.affiliation: Cardiothoracic Surgical Unit, Walsgrave Hospital, Coventry, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Wilkinson
authors.forename: W G
authors.initials: WG
authors.lastname: Williams
mesh_terms: D000328:Adult; D001021:Aortic Valve; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D014261:Tricuspid Valve
chemical_list: D013300:Streptokinase