Case report of successful low-dose, ultra-slow infusion thrombolysis of prosthetic mitral valve thrombosis in a high risk patient after redo-mitral valve replacement
| Autor: | Felix C. Tanner, Ioannis Kapos, Tobias A. Fuchs |
|---|---|
| Přispěvatelé: | University of Zurich, Kapos, Ioannis |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Pannus 610 Medicine & health Case Reports 030204 cardiovascular system & hematology Valve disease 2705 Cardiology and Cardiovascular Medicine 03 medical and health sciences 0302 clinical medicine Mechanical prosthesis Valve replacement Case report Fibrinolysis medicine 030212 general & internal medicine Thrombus Prosthetic Valve Thrombosis Computed tomography Cardiac Imaging (Echocardiography / Cardiac MRI / Nuclear Cardiology) business.industry Mitral valve replacement Thrombolysis medicine.disease Thrombosis Surgery Echocardiography 10209 Clinic for Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal: Case Reports |
| Popis: | Background An increase in transvalvular pressure gradient of prosthetic valve should always raise suspicion for obstructive valve thrombosis. A multimodality diagnostic approach including transthoracic echocardiography, transoesophageal echocardiography (TOE), cinefluoroscopy, or computed tomography (CT) is necessary for a prompt diagnosis. The management of mechanical prosthetic valve thrombosis (PVT) is high risk in any therapeutic option taken. Emergency valve replacement is recommended for critically ill patients. Fibrinolysis is an alternative for patients with contraindication to surgery or if surgery is not immediately available. Case summary A 52-year-old woman presented with symptoms and signs of cardiac congestion. On laboratory, brain natriuretic peptide was elevated and international normalized ratio (INR) was in subtherapeutic range. She underwent a mitral valve replacement with mechanical prosthesis 7 months before, because of a significant residual regurgitation after repair on the same year. TOE revealed severe stenosis of the prosthesis with immobile anterior disc but there was no mass present. CT revealed a minor lesion at the hinge points of the prosthesis without involvement of the ring, suggestive for thrombus. The initial fruitless management with intravenous (i.v) heparin in high therapeutic range was followed by a successful ‘low-dose, ultra-slow’ fibrinolysis. Discussion CT may help differentiate thrombus vs. pannus. The acute onset of symptoms, inadequate anticoagulation, and restricted leaflet motion increased the suspicion for PVT. The current European guidelines propose normal dose fibrinolysis. We performed ‘low-dose, ultra-slow’ fibrinolysis due to lower bleeding risk with successful results. Low dose should be considered as alternative to normal dose fibrinolysis or urgent surgery. |
| Databáze: | OpenAIRE |
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