title: Paraprosthetic leak unmasked by thrombolysis for thrombosed mitral valve.
abstract: Prosthetic valve thrombosis (PVT) is classically a cardiothoracic surgical emergency. Case series, however, report thrombolysis as first line management for PVT. A case of mitral PVT treated successfully with thrombolysis is described. Immediately after thrombolysis a trivial paraprosthetic leak noted on pretreatment transoesophageal echocardiography had increased significantly in severity. The paraprosthetic leak subsequently required repeat mitral valve replacement. It is speculated that the thrombolytic treatment interfered with the usual healing process by disrupting the fibrin deposited at the valve ring margin. This suggests that fibrin is important in the formation of the annular seal of the prosthetic valve and that patients receiving thrombolysis should be monitored for this complication.
authors.affiliation: Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK. mmyusuf@doctors.org.uk
authors.forename: M M
authors.initials: MM
authors.lastname: Yusuf
authors.forename: R A
authors.initials: RA
authors.lastname: Archbold
authors.forename: A
authors.initials: A
authors.lastname: Wood
authors.forename: D
authors.initials: D
authors.lastname: Dymond
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents