REPEAT THROMBOLYSIS AND DIFFICULTIES OF O RAL ANTICOAGULANT-THERAPY IN AN INFANT WITH A MITRAL PROSTHETIC VALVE

The finding of cardiac failure in a neonate led to the diagnosis of co ngenital mitral regurgitation complicating dystrophic valves. After fa iled surgical valvuloplasty, the child underwent mitral valve replacem ent with a Saint-Jude medical prosthesis at the age of 4 months. The c hild developed four episodes of prosthetic valve thrombosis in the two years that followed. The first was treated surgically but the three o thers were treated by thrombolysis associating plasminogen tissue acti vator and urokinase. All but one of the thromboses occurred in a conte xt of recent destabilisation of oral anticoagulant therapy despite the initiation of heparin. Repeat thrombolysis was successfully undertake n, thereby widening the indications of this type of treatment in the i nfant. This case also underlines the difficulties of oral anticoagulan ts in infants.