title: Sequential use of thrombolytic agents for thrombosed mitral valve prosthesis during pregnancy.
abstract: Thrombolytic therapy has gained popularity as an alternative to surgery in the treatment of prosthetic heart valve thrombosis. We report on the sequential use of streptokinase followed by recombinant tissue type plasminogen activator (rt-PA) for the treatment of a thrombosed prosthetic mitral valve in a pregnant woman at 26 weeks of gestation. Although thrombolysis was unsuccessful, the patient carried till 34 weeks of gestation and delivered by cesarean section a live newborn with an uneventful postpartum course. Based on our case and on what has been previously described in the literature, thrombolytic therapy should be considered as an option in the management of hemodynamically unstable pregnant patients with prosthetic valve thrombosis. When a single agent proves insufficient, combination therapy should be considered as it might provide hemodynamic stability and improvement in cardiac function that would allow patients at a high surgical risk to carry their pregnancy to viability.
authors.affiliation: Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon. an21@aub.edu.lb
authors.forename: Anwar H
authors.initials: AH
authors.lastname: Nassar
authors.forename: Mazen E
authors.initials: ME
authors.lastname: Abdallah
authors.forename: George V
authors.initials: GV
authors.lastname: Moukarbel
authors.forename: Ihab M
authors.initials: IM
authors.lastname: Usta
authors.forename: Walid S
authors.initials: WS
authors.lastname: Gharzuddine
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005865:Gestational Age; D006350:Heart Valve Prosthesis; D006801:Humans; D008943:Mitral Valve; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011475:Prosthesis Failure; D011994:Recombinant Proteins; D013300:Streptokinase / Q000008:administration & dosage; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D013300:Streptokinase; D010959:Tissue Plasminogen Activator