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J Thorac Cardiovasc Surg 1998;115:780-784
© 1998 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Short-course thrombolysis as the first line of therapy for cardiac valve thrombosis

From the Thrombosis and Hemostasis Unit,^a Cardiac Surgery^b and Cardiology^c Departments, Hospital de la Sta Creu i St Pau, Barcelona, Spain.

Presented at the Thirteenth International Congress on Fibrinolysis and Thrombolysis, June 1996.

Received for publication July 18, 1997. Revisions requested Sept. 2, 1997; revisions received Sept. 29, 1997. Accepted for publication Sept. 30, 1997. Address for reprints: J. Fontcuberta, MD, PhD, Departament d'Hematologia, Unitat d'Hemostasia i Trombosi, Hospital de la Santa Creu I Sant Pau, Antoni M^a Claret 167, 08025 Barcelona, Spain.

Abstract

Objective: To retrospectively evaluate the clinical and echocardiographic criteria of thrombolytic therapy for mechanical heart valve thrombosis.
Methods: Nineteen consecutive patients with 22 instances of prosthetic heart valve thrombosis (14 mitral, 2 aortic, 3 tricuspid, and 3 pulmonary) were treated with short-course thrombolytic therapy as first option of treatment in absence of contraindications. The thrombolytic therapy protocol consisted of streptokinase (1,500,000 IU in 90 minutes) (n = 18) in one (n = 7) or two (n = 11) cycles or recombinant tissue-type plasminogen activator (100 mg in 90 minutes) (n = 4).
Results: Overall success was seen in 82%, immediate complete success in 59%, and partial success in 23%. Six patients without total response to thrombolytic therapy underwent surgery, and pannus was observed in 83%. Six patients showed complications: allergy, stroke, transient ischemic attack, coronary embolism, minor bleeding, and one death. At diagnosis, 10 patients evidenced atrial thrombus by transesophageal echocardiography, 3 of whom experienced peripheral embolism during thrombolysis. Four episodes of rethrombosis were observed (16%). The survivorship was 84% with a mean follow-up of 42.6 months.
Conclusions: A short-course of thrombolytic therapy may be considered first-line therapy for prosthetic heart valve thrombosis. The risk of peripheral embolism may be evaluated for the presence of atrial thrombus by transesophageal echocardiography at diagnosis. (J Thorac Cardiobasc Surg 1998;115:780-4)

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