title: Successful thrombolysis of late, non-obstructive mitral bioprosthetic valve thrombosis: case report and review of the literature.
abstract: Bioprosthetic valve thrombosis is an unexpected complication which has no guidelines for its management. A 70-year-old female presented 10 days after a stroke, three years after having undergone mitral bioprosthetic valve implantation. Both, transthoracic echocardiography and transesophageal echocardiography (TEE) revealed a large mobile, non-obstructive mass attached to the atrial side of the sewing ring of the bioprosthesis. The administration of low-molecular-weight heparin and aspirin resulted only in a reduction of thrombus size, whereas a slow streptokinase infusion resulted in complete disappearance of the thrombus after 16 h. A review of the literature shows that late non-obstructive bioprosthetic valve thrombosis, as diagnosed with TEE, is a rare condition that can be successfully treated either by anticoagulant or thrombolytic therapy. Late bioprosthetic valve thrombosis should be considered as a cause of prosthetic valve dysfunction, and long-term preventive anticoagulant treatment of high-risk patients is warranted. Slow thrombolytic therapy is safe and successful, even for large non-obstructive bioprosthetic thrombi, if there are no contraindications.
authors: 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary. pzoltan@kut.sote.hu
authors: Zoltan
authors: Z
authors: Pozsonyi
authors: Maria
authors: M
authors: Lengyel
mesh_terms: D000074:Acenocoumarol / Q000627:therapeutic use; D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008943:Mitral Valve; D017762:Nadroparin / Q000627:therapeutic use; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents; D017762:Nadroparin; D013300:Streptokinase; D000074:Acenocoumarol