THROMBOLYTIC THERAPY FOR MITRAL-VALVE THROMBOSIS

A 44-year-old man with a St. Jude mitral valve was admitted because of progressive pulmonary edema. He was diagnosed with prosthetic heart v alve thrombosis (PHVT) based on the findings of ''muffled'' prosthetic valve clicks, Doppler echocardiographic evidence of severe mitral ste nosis and transesophageal echocardiographic evidence of limited mitral valve motility. Because the patient hesitated to undergo our recommen ded surgical treatment, he was immediately treated with intravenous re combinant tissue plasminogen activator (100 mg over 3 h) followed by h eparinization, Two hours after the thrombolytic therapy, the prostheti c valve clicks became clearly audible and his congestive symptoms were dramatically improved. Follow-up echocardiograph! no longer showed si gnificant mitral valve obstruction. A transient cerebral ischemic atta ck occurred at the end of thrombolytic therapy but there were no neuro logic sequalae. The patient, on warfarin therapy, was well at follow-u p 8 months after discharge. Surgical intervention has long been the st andard therapy for patients with PHVT. Our case experience suggests th at thrombolytic therapy may be considered as an effective alternative to surgical intervention for selected patients with PHVT. In this repo rt, we also review the current literature regarding the indications, e ffectiveness and safety of thrombolytic therapy in PHVT.