title: Thrombolytic Therapy as the Management of Mitral Transcatheter Valve-in-Valve Implantation Early Thrombosis.
abstract: A 70-year-old male underwent mitral transcatheter valve-in-valve implantation for a failed bioprosthesis implanted 11 years earlier. In the first days following the procedure, he developed thrombosis of the new bioprosthesis with restricted cusp motion. The transmitral mean gradient increased significantly despite effective anticoagulation therapy using unfractionated heparin infusion. Low dose and slow infusion of alteplase resulted in resolution of the thrombus and normalisation of cusp motion. Thereafter long-term anticoagulation using a vitamin K antagonist was instituted and the patient remained asymptomatic.
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Nathem
authors.initials: N
authors.lastname: Akhras
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Hani
authors.initials: H
authors.lastname: Al Sergani
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Jehad
authors.initials: J
authors.lastname: Al Buraiki
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Bahaa M
authors.initials: BM
authors.lastname: Fadel
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Feras
authors.initials: F
authors.lastname: Khaliel
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Abdalkareem
authors.initials: A
authors.lastname: Al Allaf
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Amri
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. Electronic address: ziad_dahdouh@hotmail.com.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Dahdouh
mesh_terms: D000368:Aged; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D006493:Heparin
keywords: Mitral bioprosthesis; Thrombolytics; Thrombus; Transcatheter; Valve-in-valve