RECOMBINANT TISSUE-TYPE PLASMINOGEN-ACTIVATOR THERAPY IN PROSTHETIC MITRAL-VALVE THROMBOSIS - ASSESSMENT BY TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Prosthetic cardiac thrombosis is a life-threatening complication that needs prompt diagnosis and therapy. We used recombinant tissue-type pl asminogen activator (rT-PA), followed by heparin, in three patients wi th mitral prosthetic thrombosis, which was evident in two and suspect in one. Transthoracic and transesophageal echocardiography were employ ed in the diagnosis of both thrombosis and its resolution. No complica tions occurred. Immediately after the end of treatment with rT-PA, cli nical status and echocardiographic data improved in all cases: transth oracic echocardiography showed the normalization of prosthetic functio n and transesophageal echocardiography showed resolution of thrombosis . One patient needed reoperation for rethrombosis due to the presence of prosthetic fibrous clot. rT-PA, followed by heparin, led to a good clinical result without bleeding and embolic complications in selected patients with mitral prosthetic thrombosis. Transthoracic and transes ophageal echocardiography are complementary diagnostic tools in the di agnosis and management of patients with prosthetic thrombosis.