title: [Thrombolysis in left mechanical prosthetic heart valve obstruction by thrombus. Following and results].
abstract: BACKGROUND
  Obstruction of the left mechanical heart valve by a thrombus is a serious complication. The factors associated with mortality are functional class, type of valve prosthesis and emergency surgery. Thrombolysis represents a therapeutic option to cardiac surgery. The aim of this investigation was to analyze the role of thrombolysis in the management of thrombus-obstructed left mechanical heart valve.
  
  
  METHODS
  Twenty-two consecutive cases undergoing thrombolysis at the Cardiology Hospital of the Siglo XXI National Medical Center were studied under two different circumstances: with acute pulmonary edema and state of shock in functional class IV and with functional class I-II. Clinical and echocardiographic monitoring and fluoroscopy were performed.
  
  
  RESULTS
  The response was satisfactory in 56 % of the patients and there were complications in 69 % of the cases. During the follow-up, recurrence of symptoms occurred in 25 % of the patients, 5-year actuarial survival in 75 % and thromboembolic events-free survival in 37 %. Mortality was 12 %.
  
  
  CONCLUSIONS
  Thrombolysis is a management alternative in patients with thrombus-obstructed left mechanical heart valve; however, this therapeutic option must be choosen according to clinical circumstances and echocardiographic, hemodynamic or fluoroscopic findings in the patients.
authors.affiliation: Dirección de Educación e Investigación en Salud, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México. jesus.valencia@imss.gob.mx.
authors.forename: Jesús Salvador
authors.initials: JS
authors.lastname: Valencia-Sánchez
authors.forename: Roberto
authors.initials: R
authors.lastname: Arriaga-Nava
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D004334:Drug Administration Schedule; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000188:drug therapy* / Q000209:etiology; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications / Q000188:drug therapy*; D012042:Registries; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Heart valve prosthesis; Thrombolytic therapy; Thrombosis