Successful thrombolysis of a partially obstructed bileaflet prosthetic heart valve in the mitral position.
We describe the case of a woman who presented with dyspnea of abrupt onset and who had recently undergone replacement of the mitral valve with a bileaflet mechanical prosthesis. Transthoracic echocardiographic examination with spectral Doppler recording of transvalvular blood flow revealed a velocity spectrum consistent with obstruction. Transesophageal echocardiography demonstrated partial obstruction of the prosthetic valve due to immobilization of 1 hemidisc in the closed position. This immobilization was apparently caused by a small mass whose appearance was consistent with that of a thrombus. The patient was successfully treated by intravenous administration of a thrombolytic agent. This case demonstrates the value of transesophageal echocardiography in the selection of candidates for thrombolytic treatment in cases of thrombosis of a left-sided valve prosthesis.
Barbetseas
John
J
Department of Cardiology, University of Athens, Hippokration Hospital, 24 Aslanoglou Street, Athens 17671, Greece.
Vitalis
Michael
M
Vyssoulis
Gregory
G
Lambrou
Spyros
S
Aggeli
Constantina
C
Marinakis
Nicholas
N
Toutouzas
Pavlos
P
D000368:Aged; D004417:Dyspnea / Q000209:etiology; D017548:Echocardiography, Transesophageal; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D013300:Streptokinase / Q000627:therapeutic use*; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase