Thrombolytic therapy for a thrombosed Bjork-Shiley tricuspid valve prosthesis.
A 67-year-old mand in whom mitral and tricuspid Bjork-Shiley tilting disc prostheses had been implanted 68 months previously presented with thrombotic obstruction of his tricuspid prosthesis. Initial cardiac catheterization demonstrated a significant transprosthetic tricuspid diastolic gradient (9.5 mmHg) with a calculated prosthetic valve orifice area (0.62 cm2) indicating a critical degree of stenosis. The resting cardiac index was markedly reduced (1.5 l/m2/min). Following an intravenous infusion of streptokinase for 66 hours, repeat cardiac catheterization revealed a 50% reduction in transprosthetic diastolic gradient across the tricuspid valve (4.7 mmHg), a greater than fourfold increase in prosthetic valve orifice area (2.87 cm2) with a normal resting cardiac index (3.1 l/m2/min).
D000368:Aged; D006328:Cardiac Catheterization; D006350:Heart Valve Prosthesis; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D013300:Streptokinase / Q000008:administration & dosage*; D013927:Thrombosis / Q000188:drug therapy*; D014261:Tricuspid Valve
D013300:Streptokinase