title: [Ultra-high dosage streptokinase lysis in dysfunction of a St. Jude aortic prosthesis].
abstract: METHODS
  A 64-year-old man was hospitalised because of progressively worsening dyspnoea over the preceding few months. Three years previously he had undergone aortic valve replacement (St. Jude Medical bileaflet valve) for severe aortic stenosis and some regurgitation. He was much improved postoperatively and one year after the operation echocardiography demonstrated a well functioning prosthetic valve and a transvalvar pressure gradient (by Doppler echocardiography) of 28 mm Hg. On admission the patient reported to have stopped phenprocoumon 9 months before admission. The patient was in cardiac failure, grade III (NYHA classification). On auscultation there was a 4/6 crescendo-decrescendo systolic murmur and a 2/6 early diastolic decrescendo murmur maximal over the second right ICS.
  
  
  METHODS
  Echocardiography confirmed the suspected diagnosis of dysfunction of the prosthetic valve, one leaflet being immobile, with severe outflow obstruction (peak transvalvar pressure gradient 101 mm Hg) combined with severe regurgitation. At fluoroscopy one leaflet moved normally, the other one being fixed between opening and closing positions.
  
  
  METHODS
  As thrombosis was the most likely cause of the prosthetic valve dysfunction, thrombolysis treatment was started. After administration of 9 mill. IU streptokinase both leaflets showed normal movement. The peak transvalvar gradient (by echocardiography) was now 40 mm Hg and there was only slight regurgitation. No complications were noted. After oral anticoagulation for 6 months the prosthetic valve was functioning normally with unchanged movement pattern of both leaflets.
  
  
  CONCLUSIONS
  Thrombolysis may be successful in thrombotic dysfunction of a prosthetic valve. If there are no contraindications, this form of treatment should be tried before reoperation is undertaken.
authors.affiliation: Klinik für Innere Medizin I, Abteilung für Kardiologie und Angiologie, Stadtkrankenhaus Worms.
authors.forename: H
authors.initials: H
authors.lastname: Mertes
authors.forename: W
authors.initials: W
authors.lastname: Schmalz
authors.forename: M
authors.initials: M
authors.lastname: Hüttemann
authors.forename: E
authors.initials: E
authors.lastname: Roth
authors.forename: P
authors.initials: P
authors.lastname: Limbourg
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D015150:Echocardiography, Doppler; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014172:Transillumination
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase
vernacular_title: Ultrahochdosierte Streptokinase-Lyse bei Dysfunktion einer St.-Jude-Aortenprothese.