Unusual presentation of mitral prosthetic heart valve thrombosis managed with low dose tenecteplase infusion

2021 ◽  
pp. 1-3
Author(s):  
A. Shaheer Ahmed ◽  
Shivank Gupta
Keyword(s):  
Prosthetic Valve ◽  
Low Dose ◽  
Prosthetic Heart Valve ◽  
Low Grade ◽  
Prosthetic Valve Thrombosis ◽  
Echocardiographic Evaluation ◽  
Dose Infusion ◽  
Valve Thrombosis ◽  
History Of ◽  
Heart Valve Thrombosis

Abstract A 11-year-old with history of mitral valve replacement presented with low-grade fever, breathlessness and multiple episodes of haemoptysis for 2 days. Detailed echocardiographic evaluation revealed possible prosthetic valve thrombosis, which was confirmed by fluoroscopy. She was thrombolysed with low dose infusion of tenecteplase. Post thrombolysis her symptoms improved, valve mobility was restored, and haemoptysis subsided. Left sided prosthetic valve thrombosis presenting predominantly with haemoptysis is very rare.

Fibrinolysis in left-sided mechanical prosthetic valve thrombosis with high INR

2019 ◽  
Vol 9 (3_suppl) ◽  
pp. S58-S62 ◽  
Author(s):  
KR Nishanth ◽  
Mythri Shankar ◽  
KH Srinivasa ◽  
CN Manjunath ◽  
KS Ravindranath
Keyword(s):  
Ischaemic Stroke ◽  
Prosthetic Valve ◽  
Low Dose ◽  
Minor Bleeding ◽  
Prosthetic Valve Thrombosis ◽  
Conventional Dose ◽  
International Normalised Ratio ◽  
Dose Infusion ◽  
Delayed Initiation ◽  
Valve Thrombosis

Background: A significant number of patients with prosthetic valve thrombosis have a prothrombin time international normalised ratio in the therapeutic range at presentation. Surgery may not be possible in many patients and traditionally a high international normalised ratio is considered a relative contraindication for fibrinolysis. Methods: We conducted an observational study in patients with left-sided obstructive prosthetic valve thrombosis with international normalised ratio at or above the therapeutic range at presentation who received fibrinolysis. The fibrinolytic regimens, timing of initiation, success of fibrinolysis, risk of major and minor bleeding and ischaemic stroke were evaluated in the study. Results: Of 30 patients included in the study 70% received immediate fibrinolysis and in 30% it was delayed. The majority of patients (90%) presented with New York Heart Association class III/IV symptoms. The mean international normalised ratio at fibrinolysis was 3.04 ± 0.70 in the immediate group and 2.42 ± 0.89 in the delayed group. Haemodynamically stable patients who had delayed initiation of fibrinolysis had a trend towards less bleeding without an increase in mortality. The rates of intracranial haemorrhage (0% vs. 7.7%), minor bleeding (12.5% vs. 25.1%) and ischaemic stroke (0% vs. 30.7%) were lower in patients who received low dose infusion compared to a conventional dose. Conclusions: Fibrinolysis can be considered in patients with prosthetic valve thrombosis with high international normalised ratio at presentation. For haemodynamically stable patients, delayed initiation of fibrinolysis is associated with a marginally lower bleeding risk without an increase in mortality. Low dose infusion may be considered over a conventional dose as it is associated with a lower incidence of ischaemic stroke and a good rate of valve function restoration with a trend towards less bleeding.

scholarly journals Risk Factors Associated with Heart Valve Thrombosis in Patients with Prosthetic Heart Valve Dysfunction

2020 ◽  
Vol 23 (9) ◽  
pp. 600-604
Author(s):  
Feridoun Noohi Bezanjani ◽  
Sepehr Gohari ◽  
Hossein Ali Bassiri ◽  
Hassan Ahangar ◽  
Tara Reshadmanesh
Keyword(s):  
Heart Valve ◽  
Prosthetic Valve ◽  
Fibrinogen Level ◽  
Laboratory Data ◽  
Prosthetic Heart Valve ◽  
Plasma Fibrinogen ◽  
Plasma Fibrinogen Level ◽  
Valve Thrombosis ◽  
History Of ◽  
Heart Valve Thrombosis

Background: Thrombotic and thromboembolic events are important causes of mortality and morbidity in patients with prosthetic heart valve. The aim of this study is to evaluate the factors that may contribute to prosthetic heart valve thrombosis. Methods: This was a cross-sectional study in Rajaie Heart Center on patients with prosthetic heart valve malfunction, within a year. According to the echocardiographic and fluoroscopic findings, the patients were divided into two groups (thrombosis and non-thrombosis groups). The patients’ demographic, clinical and laboratory data were recorded and analyzed with SPSS software. Results: A total of 142 patients participated in this study. Ninety-four patients (66.2%) were diagnosed with thrombosis. There was a significant relationship between thrombosis and inadequate anti-coagulation (international normalized rati [INR] <2.5) (odds ratio [OR]: 4.15, 95% CI: 1.98-9.87, P = 0.003), history of infection (OR: 12.81, 95% CI: 3.52-19.02, P<0.001), prothrombin time (PT) check interval (OR: 2.38, 95% CI: 1.63-8.47, P = 0.019), atrial fibrillation (AF) rhythm (OR: 3.96, 95% CI: 1.75-8.09, P = 0.019), and plasma fibrinogen level (OR: 6.90, 95% CI: 2.58-14.69). Conclusion: Based on this study, inadequate anti-coagulation, AF rhythm, recent infection and plasma fibrinogen level were the factors most contributing to prosthetic valve thrombosis. As there were many cases of thrombosis in patients with history of infection, this factor can be considered for risk assessment in prosthetic valve.

scholarly journals Thrombolytic therapy in prosthetic valve thrombosis in the second trimester of pregnancy

2020 ◽  
Vol 7 (5) ◽  
pp. 853
Author(s):  
Santhosh Jadhav ◽  
H. S. Natraj Setty ◽  
Shankar S. ◽  
Phani Teja Mundru ◽  
Yeriswamy M. C. ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Mechanical Valve ◽  
Second Trimester ◽  
Prosthetic Valve Thrombosis ◽  
First Line Therapy ◽  
Mechanical Valves ◽  
Valve Thrombosis

Pregnancy with mechanical valves requires anticoagulation, the risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected. Prosthetic valve thrombosis during pregnancy requires immediate therapy such as valve replacement, thrombolytic therapy, or surgical thrombectomy. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. We describe a primigravida (second trimester) with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.

Low Dose and Slow/Ultra-Slow Infusion Thrombolytic Therapy Regimens are Effective and Safe in Patients With Prosthetic Valve Thrombosis

2020 ◽  
Vol 29 (3) ◽  
pp. e29-e30
Author(s):  
Ahmet Guner ◽  
Macit Kalcik ◽  
Sabahattin Gunduz ◽  
Semih Kalkan ◽  
Mustafa Ozan Gursoy ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Prosthetic Valve ◽  
Low Dose ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
Slow Infusion

Thrombolytic therapy for prosthetic valve thrombosis: A study based on serial Doppler echocardiographic evaluation

1992 ◽  
Vol 123 (6) ◽  
pp. 1575-1580 ◽  
Author(s):  
Ramachandran S. Vasan ◽  
Upendra Kaul ◽  
Sanjeev Sanghvi ◽  
T. Kamlakar ◽  
Prakash C. Negi ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Prosthetic Valve ◽  
Prosthetic Valve Thrombosis ◽  
Echocardiographic Evaluation ◽  
Valve Thrombosis

scholarly journals Successful Low-Dose tPA for Mechanical Mitral Valve Thrombosis in a Patient with Postinfarction Contained Left Ventricular Free Wall Rupture

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
James Livesay ◽  
Emmanuel Isang ◽  
Hassan Tahir ◽  
Raj Baljepally
Keyword(s):  
Mitral Valve ◽  
Prosthetic Valve ◽  
Low Dose ◽  
Bleeding Risk ◽  
Left Ventricular ◽  
Free Wall ◽  
Left Ventricular Free Wall ◽  
Prosthetic Valve Thrombosis ◽  
Free Wall Rupture ◽  
Valve Thrombosis

Prosthetic valve thrombosis is a potentially life-threatening complication diagnosed by a combination of clinical features and imaging modalities, but the optimal management in high bleeding risk patients remains controversial. Current treatment options for prosthetic valve thrombosis included surgery, thrombolytic therapy, and anticoagulation. We present a very unusual case of a patient with a recent ST-elevation myocardial infarction complicated by contained left ventricle free wall rupture and mechanical mitral valve thrombosis. Deemed a high surgical risk candidate, low-dose tissue plasminogen activator was used despite significant bleeding risk from contained left ventricle free wall rupture, which resulted in resolution of the thrombus. To the best of our knowledge, this is the first report of successful thrombolytic therapy for prosthetic mechanical mitral valve thrombosis in a patient with recent postmyocardial infarction contained left ventricular free wall rupture.

scholarly journals Severe Vascular Complications Following Thrombolytic Therapy in a Case of Prosthetic Mitral Valve Thrombosis – A Case Report

2021 ◽  
Vol 10 (14) ◽  
pp. 1035-1038
Author(s):  
Ayan Husain ◽  
Shilpa Abhay Gaidhane ◽  
Priti Abhay Karadbhajane ◽  
Sourya Acharya ◽  
Apoorva Nirmal
Keyword(s):  
Thrombolytic Therapy ◽  
Prosthetic Valve ◽  
Prosthetic Heart Valve ◽  
Vascular Complications ◽  
Mechanical Valve ◽  
Fibrinolytic Therapy ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
Prosthetic Mitral Valve ◽  
Immediate Surgery

Prosthetic cardiac valve thrombosis is a rare but dangerous complication; 1,2 particularly in patients with low conformity on anticoagulant therapy. Thromboembolic problems happen after mechanical valve substitution in 0.5 - 8 percent. 3-5 Fibrinolytic therapy to treat the thrombosis is widely used nowadays with high efficacy and no severe side effects as compared to emergency surgical treatment, which is associated with high mortality.6 Surgical valve repair in patients with rheumatic heart disease remains the gold standard for the treatment. Thrombosis of the prosthetic heart valve in patients undergoing valve replacement, is the most severe and deadly complication. Currently, the treatments available for symptomatic prosthetic valve thrombosis are immediate surgery or thrombolytic therapy (TT). In rural hospital settings patients are poor and there is a lack of surgical expertise. These factors make TT the perfect treatment for prosthetic valve thrombosis. But one should be aware of embolic complications.

scholarly journals Prosthetic thrombosis and coronary embolism during pregnancy: a delicate situation of antithrombotic therapy management

2019 ◽  
Author(s):  
Abdelilah Ben El Makki ◽  
Mohammed Malki ◽  
Hicham Faliouni ◽  
Mohammed Sabry
Keyword(s):  
Antithrombotic Therapy ◽  
Prosthetic Valve ◽  
Mechanical Heart Valve ◽  
Pregnant Patient ◽  
Invasive Approach ◽  
Prosthetic Valve Thrombosis ◽  
Valve Thrombosis ◽  
St Elevation ◽  
Coronary Embolism ◽  
Heart Valve Thrombosis

Mechanical heart valve thrombosis is not so rare in pregnant women because of the difficulties in managing anticoagulant treatment and the hypercoagulability state associated with pregnancy. Among the embolic complications of valve prosthetic thrombosis, the coronary embolism is rare, it requires an urgent pharmaco-invasive approach which must be adapted to this particular associated condition. We report the observation and the difficulties of managing antithrombotic therapy in a pregnant patient hospitalized for non-obstructive prosthetic valve thrombosis complicated by coronary embolism and resulting in ST elevation myocardial infarction.

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