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The Annals of Thoracic Surgery, Vol 57, 365-370, Copyright © 1994 by The Society of Thoracic Surgeons
N Vitale, A Renzulli, F Cerasuolo, A Caruso, M Festa, L de Luca and M Cotrufo
An acute obstruction is a life-threatening complication of mechanical valve
prostheses, and is caused by the formation of fresh clot or fibrous tissue
overgrowth, or both. Accurate selection of the most appropriate treatment
for a particular patient is mandatory. From January 1991 to July 1992, 28
cases of prosthetic thrombosis were managed. Twenty patients underwent
surgical treatment, with one operative death, and 8 patients were treated
with thrombolysis using recombinant tissue-type plasminogen activator
(rt-PA). The criteria for using thrombolysis were (1) the recent onset of
symptoms, (2) transesophageal echocardiographic evidence of clots on the
valve or cardiac chambers, and (3) preserved disc excursions. All patients
who underwent thrombolysis had mechanical valves (two bileaflets, four
tilting discs, and two ball valves); seven valves were in the mitral
position and one was in the aortic. Symptoms of obstruction consisted of
cardiac failure in 6 cases or thromboembolism in 5, or both. The mean
interval between the onset of symptoms and the initiation of thrombolysis
was 81 +/- 65 hours. After infusion of the rt-PA, normal valve function was
restored in all patients, as documented by transesophageal
echocardiography. No deaths or neurologic complications occurred; there was
one episode of minor peripheral embolism. Thrombolysis using rt-PA may be
the appropriate treatment in patients with primary thrombosis of mechanical
valves, thereby avoiding the operation-related risks.
ARTICLES
Prosthetic valve obstruction: thrombolysis versus operation
Institute of Cardiac Surgery, Medical School, Monaldi Hospital, Second University of Naples, Italy.
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