title: Systemic thrombolysis: cure for prosthetic mitral valve thrombosis in the comorbid, non-surgical candidate.
abstract: Severe haemolytic anaemia is a rare complication of prosthetic valve thrombosis (PVT). Emergent surgical replacement of the affected valve is normally the treatment of choice unless contraindicated, such as in high surgical risk patients. Systemic thrombolysis is the alternative to surgical valve replacement. The purpose of this report is to highlight the unique case of an elderly man with New York Heart Association class IV heart failure, history of extensive cardiopulmonary surgeries and haemorrhagic stroke, who presented with severe haemolytic anaemia secondary to prosthetic mitral valve thrombosis. After weighing the risks and benefits, our decision was to use systemic thrombolytic therapy, even in light of the patient's previous intracranial haemorrhage. Pretreatment and post-treatment Doppler echocardiography showed markedly reduced regurgitant jetting that ultimately resolved completely, thereby eliminating the underlying cause of haemolysis and achieving symptom resolution.
authors.affiliation: Hackensack University Medical Center, Hackensack, New Jersey, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Beckord
authors.affiliation: Department of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Berkowitz
authors.affiliation: Hackensack University Medical Center, Hackensack, New Jersey, USA.
authors.forename: Cholene
authors.initials: C
authors.lastname: Espinoza
authors.affiliation: Department of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Anand
mesh_terms: D000368:Aged; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008943:Mitral Valve; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator