THROMBOLYSIS IN LEFT-SIDED PROSTHETIC VALVE OCCLUSION - IMMEDIATE ANDFOLLOW-UP RESULTS

Thrombolytic therapy is used increasingly for prosthetic valve thrombo sis. Fear of peripheral embolism has limited its use in left-sided val ve occlusions. Thirty-eight patients with prosthetic valve occlusion w ere treated with thrombolytic agents on 44 occasions. Duration of thro mbolytic therapy was individualized. Patients were followed up with cl inical, echocardiographic, and cinefluoroscopic evaluation. Average ti me from onset of symptoms to presentation was 9.7 days. The anticoagul ation status was inadequate in 70% of instances. The majority (75%) we re in functional class IV, 8 of them being in shock. Overall success w as seen in 88.6%: immediate complete success in 18 and partial in 21. Nine of those with partial success had delayed opening of the leaflets . There were nine instances of rethrombosis and one instance of re-ret hrombosis; 6 patients received repeat thrombolysis with success in 5. Seventy-six percent (29/38) of the patients were surviving at the time of reporting. In conclusion, the present study demonstrates the feasi bility of thrombolytic therapy for left-sided prosthetic valve occlusi on. Delayed opening is common in patients with initial partial success . Rethrombosis remains a major problem.