[Thrombolysis of prosthetic heart valve thrombosis using recombinant tissue plasminogen activator (rt-PA) in infancy and childhood].
Thrombotic obstruction of a mechanical cardiac valve prosthesis requires urgent therapy. We report on the treatment of prosthetic valve thrombosis with recombinant tissue plasminogen activator (rt-PA) in three children at the age of 4, 10 and 18 months, in whom a St. Jude Medical prosthesis had been placed at the atrioventricular valve level 2 to 6 weeks earlier. The initial rt-PA dose was 0.4 mg/kg given over 15 min and followed by a continuous daily infusion of 1.6 to 2.0 mg/kg. In addition the patients received heparin (200 U/kg/d). Thrombolytic therapy was administered for a range of 4 to 28 days. The therapy was successful in the first case. The second child had four recurrent events of prosthetic valve thrombosis and the thrombolytic therapy was successful three times. However, the prosthesis had to be finally replaced. In the third case the thrombolytic therapy was only partially successful due to an organized thrombus requiring prosthesis replacement.
Serpi
M
M
Universitätskinderklinik Abt. für Kinderkardiologie Im Neuenheimer Feld 153 69120 Heidelberg, Germany.
Schmidt
K G
KG
Kreuz
W
W
Bucsenez
D
D
Springer
W
W
Hagl
S
S
Ulmer
H E
HE
D000367:Age Factors; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011475:Prosthesis Failure; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012086:Reoperation; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014261:Tricuspid Valve
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator