Abciximab treatment for obstructive prosthetic aortic and mitral valve thrombosis in the presence of large thrombi, cardiogenic shock, and acute evolving embolic stroke.
Obstructive thrombosis of left-sided mechanical prosthetic valves is a life-threatening complication. Intravenous thrombolytic therapy is contraindicated due to risk of clot embolization and surgical treatment is often required for hemodynamically unstable patients. We report for the first time the successful use of abciximab in the management of a patient in cardiogenic shock with multiple prosthetic valve obstructive thrombosis and evolving embolic stroke. Serial Doppler echocardiography and cinefluoroscopy demonstrated resolution of thrombi, improvements in transvalvular gradients and improvement in leaflet motion. This observation suggests abciximab should be considered as a therapeutic option in the treatment of obstructed prosthetic heart valves.
Rahman
Atiar M
AM
Department of Internal Medicine/Cardiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
Birnbaum
Yochai
Y
Mandava
Pitchaiah
P
Ahmad
Masood
M
D000077284:Abciximab; D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001021:Aortic Valve / Q000473:pathology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D011475:Prosthesis Failure; D011859:Radiography; D012770:Shock, Cardiogenic / Q000150:complications*; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab