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Paraprosthetic leak unmasked by thrombolysis for thrombosed mitral valve
  1. M M Yusuf1,
  2. R A Archbold2,
  3. A Wood1,
  4. D Dymond2
  1. 1Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, London, UK
  2. 2Department of Cardiology, St Bartholomew’s Hospital
  1. Correspondence to:
    Mr M M Yusuf
    Department of Cardiothoracic Surgery, London Chest Hospital, Bonner Road, London E2 9JX, UK;


Prosthetic valve thrombosis (PVT) is classically a cardiothoracic surgical emergency. Case series, however, report thrombolysis as first line management for PVT. A case of mitral PVT treated successfully with thrombolysis is described. Immediately after thrombolysis a trivial paraprosthetic leak noted on pretreatment transoesophageal echocardiography had increased significantly in severity. The paraprosthetic leak subsequently required repeat mitral valve replacement. It is speculated that the thrombolytic treatment interfered with the usual healing process by disrupting the fibrin deposited at the valve ring margin. This suggests that fibrin is important in the formation of the annular seal of the prosthetic valve and that patients receiving thrombolysis should be monitored for this complication.

  • thrombolysis
  • prosthetic valve thrombosis
  • paraprosthetic leak
  • PVT, prosthetic valve thrombosis
  • TOE, transoesophageal echocardiography

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