Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1980 Nov;44(5):545–554. doi: 10.1136/hrt.44.5.545

Fibrinolytic treatment of thrombus on prosthetic heart valves.

S Witchitz, C Veyrat, P Moisson, N Scheinman, L Rozenstajn
PMCID: PMC482443  PMID: 7437196

Abstract

Fibrinolytic agents were administered for 13 episodes of thrombus formation on mitral or aortic valvar prostheses in 12 patients. The most common presenting features were pulmonary oedema (six cases) or arterial emboli (six cases). The diagnosis of thrombus formation was made by phonocardiography on the following criteria: (a) modifications of the prosthetic sounds (12 cases), (b) appearance of a valvar obstructive syndrome (10 cases). The treatment consisted of streptokinase (100 000 units/h after a loading dose, seven cases) or urokinase using either low doses (75 000 or 112 500 units/h, three cases) or moderate doses (150 000 units/h, three cases) for one to four days. Immediate complete regression of clinical and phonocardiographic anomalies was seen in eight cases. Incomplete improvement was seen in two patients, leading to operation: this was unsuccessful in one patient who had surgery on the third day, and was successful in the other on the 75th day. There were three failures leading to successful reoperative procedures in two patients and to an early death in the third patient suffering from acute myocardial infarction. One non-fatal haemopericardium was observed in a patient treated with streptokinase. No important side effect was noted during delivery in a pregnant woman. During subsequent follow-up, a recurrent episode of thrombus formation was observed in one patient, treated by fibrinolytic therapy with success. One patient had an operation for a valve replacement six months after fibrinolytic treatment because of non-thrombotic valvar dysfunction; the outcome was fatal. Six patients are alive and in good condition, with a follow-up of six months to five years.

Full text

PDF
545

Images in this article

552Image
on p.552
552Image
on p.552
553Image
on p.553

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baille Y., Choffel J., Sicard M. P., Malmejac C., Metras D., Delaye A., Manuel C., Houel J. Traitement thrombolytique des thromboses de prothèse valvulaire. Nouv Presse Med. 1974 May 11;3(19):1233–1233. [PubMed] [Google Scholar]
  2. Barnhorst D. A., Oxman H. A., Connolly D. C., Pluth J. R., Danielson G. K., Wallace R. B., McGoon D. C. Long-term follow-up of isolated replacement of the aortic or mitral valve with the Starr-Edwards prosthesis. Am J Cardiol. 1975 Feb;35(2):228–233. doi: 10.1016/0002-9149(75)90006-5. [DOI] [PubMed] [Google Scholar]
  3. Ben-Zvi J., Hildner F. J., Chandraratna P. A., Samet P. Thrombosis on Bjork-Shiley aortic valve prosthesis. Clinical, arteriographic, echocardiographic and therapeutic observations in seven cases. Am J Cardiol. 1974 Oct 3;34(5):538–544. doi: 10.1016/0002-9149(74)90124-6. [DOI] [PubMed] [Google Scholar]
  4. Bernal-Ramirez J. A., Phillips J. H. Echocardiographic study of malfunction of the Bjork-Shiley prosthetic heart valve in the mitral position. Am J Cardiol. 1977 Sep;40(3):449–453. doi: 10.1016/0002-9149(77)90170-9. [DOI] [PubMed] [Google Scholar]
  5. Berndt T. B., Goodman D. J., Popp R. L. Echocardiographic and phonocardiographic confirmation of suspected caged mitral valve malfunction. Chest. 1976 Aug;70(2):221–230. doi: 10.1378/chest.70.2.221. [DOI] [PubMed] [Google Scholar]
  6. Brodie B. R., Grossman W., McLaurin L., Starek P. J., Craige E. Diagnosis of prosthetic mitral valve malfunction with combined echo-phonocardiography. Circulation. 1976 Jan;53(1):93–100. doi: 10.1161/01.cir.53.1.93. [DOI] [PubMed] [Google Scholar]
  7. Brogden R. N., Speight T. M., Avery G. S. Streptokinase: a review of its clinical pharmacology, mechanism of action and therapeutic uses. Drugs. 1973;5(5):357–445. doi: 10.2165/00003495-197305050-00002. [DOI] [PubMed] [Google Scholar]
  8. Fernandez J., Samuel A., Yang S. S., Sumathisena, Gooch A., Maranhao V., Lemole G. M., Goldberg H. Late thrombosis of the aortic Bjork-Shiley prosthesis. Its clinical recognition and management. Chest. 1976 Jul;70(1):12–16. doi: 10.1378/chest.70.1.12. [DOI] [PubMed] [Google Scholar]
  9. GARAMELLA J. J., LYNCH M. F., SCHMIDT W. R., JENSEN N. K. FATAL CLOTTING OF THE STARR-EDWARDS MITRAL BALL VALVE NINETEEN MONTHS POSTOPERATIVELY. J Thorac Cardiovasc Surg. 1964 May;47:673–680. [PubMed] [Google Scholar]
  10. Inberg M. V., Havia T., Arstila M. Thrombolytic treatment for thrombotic complication of valve prosthesis after tricuspid valve replacement. A case report. Scand J Thorac Cardiovasc Surg. 1977;11(3):195–198. [PubMed] [Google Scholar]
  11. Louis P., Duzer A., Faure D., Bouhey J. La "maladie de la bille" des valves de Starr aortiques. Coeur Med Interne. 1970 Jul;9(3):263–280. [PubMed] [Google Scholar]
  12. Luluaga I. T., Carrera D., D'Oliveira J., Cantaluppi C. G., Santin H., Molteni L., Ferreira R., Zwolinski E., De Luluaga 2nd Successful thrombolytic therapy after acute tricuspid-valve obstruction. Lancet. 1971 May 22;1(7708):1067–1068. doi: 10.1016/s0140-6736(71)91627-8. [DOI] [PubMed] [Google Scholar]
  13. Miller H. C., Gibson D. G., Stephens J. D. Role of echocardiography and phonocardiography in diagnosis of mitral paraprosthetic regurgitation with Starr-Edwards prostheses. Br Heart J. 1973 Dec;35(12):1217–1225. doi: 10.1136/hrt.35.12.1217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pfeifer J., Godlschlager N., Sweatman T., Gerbode F., Selzer A. Malfunction of mitral ball valve prosthesis due to thrombus. Report of 2 cases with notes on early clinical diagnosis. Am J Cardiol. 1972 Jan;29(1):95–99. doi: 10.1016/0002-9149(72)90422-5. [DOI] [PubMed] [Google Scholar]
  15. Sarin C. L., Yalav E., Clement A. J., Braimbridge M. V. Thromboembolism after Starr valve replacement. Br Heart J. 1971 Jan;33(1):111–114. doi: 10.1136/hrt.33.1.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Spencer F. C., Trinkle J. K., Reeves J. T. Successful replacement of a thrombosed mitral ball-valve prosthesis. JAMA. 1965 Dec 13;194(11):1249–1251. [PubMed] [Google Scholar]
  17. Veyrat C., Kalmanson D., Witchitz S., Seban C., Senikies A., Chiche P. Diagnostic phonomécanographique des dysfonctionnements de prothèses valvulaires par obstruction. Coeur Med Interne. 1975 Apr-Jun;14(2):265–283. [PubMed] [Google Scholar]
  18. Vidne B., Erdman S., Levy M. J. Thromboembolism following heart valve replacement by prosthesis: survey among 365 consecutive patients. Chest. 1973 May;63(5):713–717. doi: 10.1378/chest.63.5.713. [DOI] [PubMed] [Google Scholar]
  19. Witchitz S., Veyrat C., Moisson P., Kalmanson D., Chiche P. Thromboses tardives des prothèses valvulaires mitrales et tricuspidiennes. Diagnostic phonomécanographique et traitement. A propos de 4 observations. Ann Cardiol Angeiol (Paris) 1974 Oct;23(5):399–409. [PubMed] [Google Scholar]
  20. d'Allaines C., le Guerrier A., Dubost C. Fréquence et gravité des réinterventions sur les prothèses valvulaires intracardiaques. Coeur Med Interne. 1978 Apr-Jun;17(2):183–189. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES