THROMBOLYTIC TREATMENT FOR MASSIVE THROMBOSIS OF PROSTHETIC CARDIAC VALVES

Objective: To present the efficacy of thrombolytic treatment in place of emergency surgery in massive thrombosis of prosthetic cardiac valve s (TPCV), and to set out the diagnostic criteria and the patients' evo lution. Design: Retrospective study. Setting: Coronary Care Unit of a Spanish reference hospital. Patients: 7 patients admitted into the ICU with 10 episodes of TPCV and with advanced functional class. Interven tions: The diagnosis of TPCV was arrived at through clinical data and was confirmed by Doppler-echocardiography before treatment. Thrombolyt ic treatment (streptokinase, urokinase or rt-PA) was used. The analysi s of paired samples between the data before and after treatment was us ed. Measurements and results: All the patients underwent an improvemen t in their clinical condition. A reduction of sPAP and in the mean tra nsprosthetic gradient and an increase in the effective valvular area w as achieved. Four patients needed surgical intervention during their f ollow-up. No case required emergency surgery. One patient died after s urgery and the other 6 patients are alive after follow-up of 6-33 mont hs. With the fibrinolytic treatment hemorrhagic complications were alw ays controlled. None of the treated patients presented embolic complic ations. Conclusions: Fibrinolytic treatment is the recommended initial treatment in cases of massive TPCV. When fibrinolysis is only partial ly succesful, reoperation can be performed at lower risk. Doppler echo cardiography is fundamental in the diagnosis of TPCV and in monitoring the response to fibrinolytic treatment.