[Thrombolysis in mechanical prosthetic valve thrombosis. Its management with streptokinase].
We present the first experience in Mexico in 10 patients, 9 female and 1 male with an average age of 42.5 years. All patients had clinical, echocardiographic and fluoroscopic criteria of dysfunctioning mechanical valvular prosthesis due to thrombosis (9 Sorin type and 1 Starr-Edwards). None of the patients had contraindications for thrombolytic therapy. All cases were treated with intravenous streptokinase: 250,000 U in 30 minutes followed by an infusion of 100,000 U per hour, always under clinical, echocardiographic and fluoroscopic control every 2 and 24 hours respectively until the normalization of the clinical and hemodynamic parameters with a top limit of 72 hour. The average duration of the thrombolysis was 54 +/- 6.1 hours with an average total doses of 5' 200,000 U of streptokinase. In 90% of the cases there was an increase in the valvular area: mitral (n = 7), from 1.02 +/- 0.21 to 1.75 +/- 0.36 cm2 (p < 0.001), while the mean transvalvular gradient decreased from 10.42 +/- 3.77 to 3.42 +/- 0.975 mmHg (p < 0.001); the systolic pulmonary artery pressure also decreased from 53.7 +/- 15.29 to 35 +/- 2 mmHg (p < 0.001). In the tricuspid prosthesis (n = 2) the average valvular area was increased from 0.8 +/- 0.44 to 1.55 +/- 0.77 cm2, decreasing proportionally the mean transvalvular gradient from 12.5 +/- 2 to 4.5 +/- 3.5 mmHg with no changes in the systolic pressure of the pulmonary artery. In the Starr-Edwards prosthesis in aortic position (n = 1), no hemodynamic changes were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Solorio
S
S
División de Cardiología y Angiología, Hospital de Especialidades, Centro Médico La Raza, IMSS, México, D.F.
Sánchez
H
H
Madrid
R
R
Badui
E
E
Valdespino
A
A
Murillo
H
H
Rangel
A
A
Enciso
R
R
D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D004341:Drug Evaluation; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D013927:Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014463:Ultrasonography
D013300:Streptokinase
Trombolisis en trombosis protésica valvular mecánica. Manejo con estreptocinasa.