International Journal of Current Medical And Applied Sciences, 2016, May, 10(3),177-180. IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Page | 177 Acute Thrombosis of Mechanical Mitral Valve Prosthesis Successfully Treated with Thrombolysis. Manjiri Naik 1 , Umar Quadri 2 , Atul Jadhav 3 , Rohan Patil 3 , Abhimanyu Kadu Patil 3 ,Sushant Yadav 3 ,Sachin Sheta 3 & Lucky Doshi 3 1 Professor 2 Assistant professor, 3 Resident , Department of Medicine, MGM’s Medical College & Hospital, Hospital Aurangabad,[MS], India. --------------------------------------------------------------------------------------------------------------------------------------- Abstract: Case report: A 35-year-old female patient a diagnosed case of rheumatic heart disease with MVR (S J Bileaflet) using mechanic prosthetic valve done 3 years back. Patient was admitted to the hospital with history of shortness of breath, hemoptysis, generalised weakness since 3 days. Findings: Clinical and laboratory findings supported thrombosis of mechanical mitral valave prosthesis. 2D-Echo was done which was suggestive of S/P MVR with Restricted Valve Movement with Raised Gradient (43mm of Hg). Conclusion: In patients with stuck bileaflet mitral valves without large clots, thrombolysis offers a valid alternative to surgery with a high success rate and minimal complications. Key words: prosthetic valve thrombosis (PVT), streptokinase, thrombolytic therapy, hemoptysis Introduction: Thrombosis is a well-recognized complication of prosthetic heart valves and is associated with substantial morbidity and mortality. Potential hazards include valve obstruction or in sufficiency, depending on the leaflet position, as well as distal embolization. A repeat operation carries a substantial risk, with mortality rate ranging from 10% to 15% in selected series [1,2], which may be two or three fold higher in critically ill patients. In 1971, Luluaga et al. [3] were the first to report thrombolytic therapy with streptokinase in stuck tricuspid valve. Three years later, Baille et al. [4] reported the use of thrombolysis in a stuck left-sided(aortic) valve. Nowadays, there are more than 200 reported cases of thrombolysis of stuck left-sided valves, with an overall 82% initial success rate, 12% thromboembolism, 5% to 10% stroke, 6% death, 5% major bleeding and 11% recurrence rate (1,5–11). The valve models involved in approximately half of the cases are older ones (caged ball or single leaflet). Information regarding bileaflet valves, which are currently the preferred mechanical prosthetic valve models, is limited. Moreover, bileaflet valves are of special interest because their delicate mechanism may lead more easily to leaflet immobilization, even with a relatively small clot. On the other hand, if the offending clot is minor, thrombolysis may be easier and safer. This report concerns the technique used to diagnose the condition, treatment strategy and documentation of the results of therapy. Ca Case Report: A 35-year-old female a diagnosed case of rheumatic heart disease with MVR (S J Bileaflet) using mechanic prosthetic valve done 3 years back. Patient was admitted to the hospital with history of shortness of breath, hemoptysis, generalised weakness since 3days. Patient was admitted in our ICU care. Physical examination revealed a average built woman with a blood pressure of 120/80 mm Hg; heart rate was 112 beats per minute, respiratory rate of 38 cycles per minute and SPO2 of 89% . Creptitations were heard at the lower third of both lung fields. Neck veins were engorged. Cardiac exam revealed tachycardia with an regular heart rate and pan systolic murmur loudest at the lower left sternal border. Address for correspondence: Dr. Umar Quadri Assistant Professor, Department of Medicine, MGM’S Medical College & Hospital, Aurangabad [MS], India. Email: [email protected]CASE REPORT Access this Article Online Subject: Medical Sciences Quick Response Code How to cite this article: Manjiri Naik, Umar Quadri, et al : Acute Thrombosis of Mechanical Mitral Valve Prosthesis Successfully Treated with Thrombolysis : International Journal of current Medical and Applied sciences; 2016, 10(3), 177-180. Website: www.ijcmaas.com
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International Journal of Current Medical And Applied Sciences, 2016, May, 10(3),177-180.
Abstract: Case report: A 35-year-old female patient a diagnosed case of rheumatic heart disease with MVR (S J Bileaflet) using mechanic prosthetic valve done 3 years back. Patient was admitted to the hospital with history of shortness of breath, hemoptysis, generalised weakness since 3 days. Findings: Clinical and laboratory findings supported thrombosis of mechanical mitral valave prosthesis. 2D-Echo was done which was suggestive of S/P MVR with Restricted Valve Movement with Raised Gradient (43mm of Hg). Conclusion: In patients with stuck bileaflet mitral valves without large clots, thrombolysis offers a valid alternative to surgery with a high success rate and minimal complications. Key words: prosthetic valve thrombosis (PVT), streptokinase, thrombolytic therapy, hemoptysis
Introduction: Thrombosis is a well-recognized complication of
prosthetic heart valves and is associated with substantial
morbidity and mortality. Potential hazards include valve
obstruction or in sufficiency, depending on the leaflet
position, as well as distal embolization. A repeat operation
carries a substantial risk, with mortality rate ranging from
10% to 15% in selected series [1,2], which may be two or
three fold higher in critically ill patients. In 1971, Luluaga
et al. [3] were the first to report thrombolytic therapy with
streptokinase in stuck tricuspid valve. Three years later,
Baille et al. [4] reported the use of thrombolysis in a stuck
left-sided(aortic) valve. Nowadays, there are more than
200 reported cases of thrombolysis of stuck left-sided
valves, with an overall 82% initial success rate, 12%
thromboembolism, 5% to 10% stroke, 6% death, 5%
major bleeding and 11% recurrence rate (1,5–11). The
valve models involved in approximately half of the cases
are older ones (caged ball or single leaflet). Information
regarding bileaflet valves, which are currently the
preferred mechanical prosthetic valve models, is limited.
Moreover, bileaflet valves are of special interest because
their delicate mechanism may lead more easily to leaflet
immobilization, even with a relatively small clot. On the
other hand, if the offending clot is minor, thrombolysis
may be easier and safer. This report concerns the
technique used to diagnose the condition, treatment
strategy and documentation of the results of therapy.
Ca Case Report:
A 35-year-old female a diagnosed case of rheumatic heart
disease with MVR (S J Bileaflet) using mechanic prosthetic
valve done 3 years back. Patient was admitted to the
hospital with history of shortness of breath, hemoptysis,
generalised weakness since 3days. Patient was admitted in
our ICU care. Physical examination revealed a average
built woman with a blood pressure of 120/80 mm Hg;
heart rate was 112 beats per minute, respiratory rate of 38
cycles per minute and SPO2 of 89% .
Creptitations were heard at the lower third of both lung
fields. Neck veins were engorged. Cardiac exam revealed
tachycardia with an regular heart rate and pan systolic