Fibrinolytic treatment for recurrent left sided prosthetic valve thrombosis
- All India Institute of Medical Sciences, New Delhi, India
- Correspondence to:
Dr Ganesan Karthikeyan
Room 22, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India; karthik_2010hotmail.com
- Accepted 26 October 2004
- EDG, end diastolic gradient
- FT, fibrinolytic treatment
- IPPG, instantaneous peak to peak gradient
- MDG, mean diastolic gradient
- PVT, prosthetic valve thrombosis
- TTE, transthoracic echocardiography
About 20–25% of patients develop recurrent thrombosis after successful thrombolysis for a first episode of prosthetic valve thrombosis (PVT).1,2 Whereas fibrinolytic treatment (FT) is an acceptable modality of treatment for a first episode of PVT, there are few data on patients with recurrent PVT. We compared the outcome of FT in patients with recurrent PVT with those treated for a first episode.
METHODS
From January 2000 to January 2003, 51 patients with 75 episodes of PVT were treated with FT. Of the 51 patients, 17 received treatment for a recurrent episode while the rest were treated for a first episode. Fifteen of the 17 patients treated for a recurrent episode had their first episode of PVT during the study period. In all, there were 26 episodes of recurrent PVT and 49 first episodes. Streptokinase was used in 59 episodes (46 first and three recurrent), and urokinase in 16 episodes (three first and 13 recurrent). Serial transthoracic echocardiography (TTE) and fluoroscopic assessment were used to guide treatment.
A protocol of prolonged fibrinolytic infusion was used. Streptokinase was given in a 250 000 U bolus over 30 minutes, followed by an infusion of 100 000 U/h. Urokinase was given in a dose of 4400 …
