Successful thrombolysis of an aortic valve prosthesis by plasminogen tissue activator during pregnancy: A case report

The authors report the case of a 28 year old woman admitted as an emergency at 15 weeks' amenorrhea for malaise with transient aphasia and orthopnoea due to massive thrombosis of a St Jude aortic valve prosthesis implanted tw o years previously. This complication occurred after relay of oral anticoag ulants with subcutaneous heparin therapy. After a medico-surgical and obstetrical discussion, the indication for thro mbolytic therapy with SO mg of rt-PA over two hours was decided with an exc ellent clinical and echocardiographic, immediate and lasting result, withou t any maternal or foetal complication. This enabled pregnancy to be continu ed to term under oral anticoagulant therapy. Caesarean section was performe d at 8 months leading to the birth of a healthy child. Echocardiographic an d radioscopic parameters in the postpartum period showed good prosthetic va lve function with no indication for reoperation. This case is original by the absence of neurological and obstetrical compli cations of thrombolysis, the continuation of pregnancy to term and complete lysis of the thrombus without replacement of the valvular prosthesis.