Thrombolysis is an effective and safe therapy in stuck bileaflet mitral valves in the absence of high-risk thrombi

OBJECTIVES We sought to evaluate the effectiveness and safety of thrombolyt ic therapy in stuck mitral bileaflet heart valves in the absence of high-ri sk thrombi. BACKGROUND Current recommendations for the thrombolytic treatment of stuck prosthetic mitral valves are partially based on older valve models and incl usion of patients in whom high-risk thrombi were either ignored or not soug ht for. The feasibility and safety of thrombolysis in bileaflet models may be affected by the predilection of thrombi to catch the leaflet hinge. METHODS We studied 12 consecutive patients (men/women = 5/7, age 58.8 +/- 1 4.9 years) who experienced one or more episodes of stuck bileaflet mitral v alve over a 33 month period and received thrombolytic therapy with streptok inase, urokinase or tissue-type plasminogen activator. Transesophageal echo cardiography was performed in all patients. Patients with mobile or large ( >5 mm) thrombi were excluded. Functional class at initial episode was I-II in 4 patients (33.3%) and III-IV in 8 patients (66.6%). RESULTS Patients receiving thrombolytic therapy achieved an overall 83.3% f reedom from a repeat operation or major complications (95% confidence inter val 51.6-97.9%). Minor bleeding occurred in three patients (25%) and allerg ic reaction in one (8.3%). Transient vague neurologic complaints, without s ubjective findings, occurred in four patients (33.3%). Three patients had o ne or more relapses within 5.2 +/- 3.1 months from the previous episode, an d readministration of thrombolytics was successful. CONCLUSIONS In clinically stable patients with stuck bileaflet mitral valve s and no high-risk thrombi, thrombolysis is highly successful and safe, bot h in the primary episode and in recurrence. The best thrombolytic regimen i s yet to be established. (J Am Coll Cardiol 2000;35:1874-80) (C) 2000 by th e American College of Cardiology.