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2014, Number 6

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Rev Med Inst Mex Seguro Soc 2014; 52 (6)

Thrombolysis in left mechanical prosthetic heart valve obstruction by thrombus. Following and results

Valencia-Sánchez JS, Arriaga-Nava R

Language: Spanish
References: 26
Page: 684-691
PDF size: 154.90 Kb.


ABSTRACT

Background: Obstruction of the left mechanical heart valve by a thrombus is a serious complication. The factors associated with mortality are functional class, type of valve prosthesis and emergency surgery. Thrombolysis represents a therapeutic option to cardiac surgery. The aim of this investigation was to analyze the role of thrombolysis in the management of thrombus-obstructed left mechanical heart valve.
Methods: Twenty-two consecutive cases undergoing thrombolysis at the Cardiology Hospital of the Siglo XXI National Medical Center were studied under two different circumstances: with acute pulmonary edema and state of shock in functional class IV and with functional class I-II. Clinical and echocardiographic monitoring and fluoroscopy were performed.
Results: The response was satisfactory in 56 % of the patients and there were complications in 69 % of the cases. During the follow-up, recurrence of symptoms occurred in 25 % of the patients, 5-year actuarial survival in 75 % and thromboembolic events-free survival in 37 %. Mortality was 12 %.
Conclusions: Thrombolysis is a management alternative in patients with thrombus-obstructed left mechanical heart valve; however, this therapeutic option must be choosen according to clinical circumstances and echocardiographic, hemodynamic or fluoroscopic findings in the patients.


REFERENCES

  1. Roudaut R, Lafi tte S, Roudaut MF, Courtault C, Perron JM, Jaïs C, et al. Fibrinolysis of mechanical prosthetic valve thrombosis. J Am Coll Cardiol. 2003;41(3):653-8. 2. Edmunds LH Jr. Thromboembolic complications of currents cardiac valvular prostheses. Ann Thorac Surg. 1982;34(1):96-106. 3 Smith JA, Westlake GW, Mullerworth MH, Skillington PD, Tatoulis J. Excellent long-term results of cardiac valve replacement with the St Jude Medical valve prosthesis. Circulation. 1993;88(Part 2):49-54.

  2. Valencia JS, Arriaga R, Martínez A, Navarro JR, Palomo JA. Manejo médico-quirúrgico en la disfunción de prótesis valvular cardiaca izquierda por obstrucción. Once años de experiencia. Arch Inst Cardiol Mex. 1999:69(2):127-33.

  3. Husebye DG, Pluth JR, Piehler JM, Schaff HV, Orszulak TA, Puga FJ, et al. Reoperation on prosthetic heart valves. An analysis of risk factors in 552 patients. J Thorac Cardiovasc Surg. 1983;86(4): 543-52.

  4. Piehler JM, Blackstone EH, Bailey KR, Sullivan ME, Pluth JR, Weiss NS, et al. Reoperation on prosthetic heart valves Patient-specifi c estimates of in hospital events. J Thorac Cardiovasc Surg. 1995;109(1): 30-48.

  5. Luluaga IT, Carrera D, Oliveira J, Cantaluppi CG, Santin H, Molteni L, et al. Successful thrombolytic therapy after acute tricuspid valve obstruction. Lancet. 1971;22(1):1067-8.

  6. Baille Y, Choffel J, Sicard MP, Malmejac C, Metras D, Delaye A, et al. Treatment fi brinolytique des tromboses de prothese valvulaire. Nouv Presse Med. 1974;3(19):1233.

  7. Witchitz S, Veyrat C, Moisson P, Scheinman N, Rozenstajn L. Fibrinolytic treatment of thombus on prosthetic heart valves. Br Heart J. 1980;44(5):545- 54. Texto libre en http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC482443/

  8. Ledain LD, Ohayon JP, Colle JP, Lorient-Roudaut FM, Roudaut RP, Besse PM. Acute thrombotic obstruction with disc valve prostheses: Diagnostic considerations and fi brinolytic treatment. J Am Coll Cardiol. 1986;7(4):743-51.

  9. Graver LM, Gelber PM, Tyras DH. The risks and benefi ts of thrombolytic therapy in acute aortic and mitral prosthetic valve dysfunction: report of a case and review of the literature. Ann Thorac Surg. 1988;46(1):85-8.

  10. Roudaut R, Labbe T, Lorient-Roudaut MF, Gosse P, Baudet E, Fontan F, et al. Mechanical cardiac valve thrombosis. Circulation. 1992; 86(Suppl 5):118-5.

  11. Silber H, Khan SS, Matloff JM, Chaux A, DeRobertis M, Gray R. The St Jude valve. Thrombolysis as the fi rst line of therapy for cardiac valve thrombosis. Circulation. 1993;87(1):30-7.

  12. Deviri E, Sareli P, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart valve prostheses: clinical aspects and surgical management. J Am Coll Cardiol. 1991;17(3):646-50.

  13. Torrado-González E, Ferriz-Martín JA, Prieto-Palomino MA, Rodríguez-García JJ, Álvarez-Bueno JM, Vera-Almazán V, et al. Trombólisis de prótesis valvulares cardiacas trombosadas: presentación de 2 casos y revisión de la literatura. Rev Esp Cardiol. 1990;43(5):345-51. Rev Med Inst Mex Seguro Soc. 2014;52(6):684-91 691 Valencia-Sánchez JS et al. Trombólisis en válvula mecánica cardiaca izquierda

  14. Vasan RS, Kaul U, Sanghvi S, Kamlakar T, Negi PC, Shrivastava S, et al. Thrombolytic therapy for prosthetic valve trombosis: A study based on serial Doppler echocardiographic evaluation. Am Heart J. 1992;123(6):1575-80.

  15. Reddy NK, Padmanabhan TN, Singh S, Kumar DN, Raju PR, Satyanarayana PV, et al. Trombolysis in leftsided prosthetic valve occlusion: Immediate and follow- up results. Ann Thorac Surg. 1994;58(2):462-70.

  16. Lengyel M, Fuster V, Keltai M, Roudaut R, Schulte H, Seward JB, et al. Guidelines for managament of left sided prosthetic valve trombosis: A role for thrombolytic therapy. J Am Coll Cardiol. 1997;30(6):1521- 6. Texto libre en http://www.sciencedirect.com/ science/article/pii/S0735109797003458

  17. Birdi I, Angelini GD, Bryan AJ. Thrombolytic therapy for left-sided prosthetic heart valve thrombosis. J Heart Valve Dis. 1995;4(2):154-9.

  18. Baudet EM, Puel V, McBride JT, Grimaud JP, Roques F, Clerc F, et al. Long-term results of valve replacement with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg. 1995;109(5):858-70.

  19. Hering D, Piper C, Horstkotte. Management of prosthetic valve thrombosis. Eur Heart J 2001;3(Suppl Q):22-6.

  20. Gupta D, Kothari S, Bahl VK, Goswami K, Talwar KK, Manchanda SC, et al. Thrombolytic therapy for prosthetic valve thrombosis: short- and long-term results. Am Heart J. 2000;140(6) 906-16.

  21. Lin SS, Tiong IY, Asher CR, Murphy MT, Thomas JD, Griffi n BP. Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography. Am J Cardiol. 2000; 86(10):1097-101.

  22. Aoyagi S, Higa Y, Matsuzoe S, Nishi Y, Tanaka K, Kawara T, et al. Obstruction of the St. Jude Medical valve diagnostic and therapeutic values cineradiography. Thorac Cardiovasc Surg. 1993;41(6):357-63.

  23. Gueret P, Vignon P, Fournier P, Chabernaud JM, Gómez M, LaCroix P, et al. Transesophageal echocardiography for the diagnosis and management of nonobstructive thrombosis of mechanical mitral valve prosthesis. Circulation. 1995;91(1):103-10. Texto libre en http://circ.ahajournals.org/content/91/1/103. long

  24. Özkan M, Kaymaz C, Kirma C, Sönmez K, Özdemir N, Balkanay M, et al. Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: A study using serial transesophageal echocardiography. J Am Coll Cardiol. 2000;35(7):1881-9.

  25. Fatkin D, Feneley M. Stratifi cation of thromboembolic risk of atrial fi brillation by transthoracic echocardiography and transesophageal echocardiography: The relative role of left atrial appendage function, mitral valve disease, and spontaneous echocardiographic contrast. Prog Cardiovasc Dis. 1996;39(1):57-68.

  26. Carabello BA, Chatterjee K, de León AC, Faxon DP, Freed MD, Gassch WH, et al. ACC/AHA 2006 Guidelines for the management of patient with valvular heart disease. J Am Coll Cardiol. 2006;48(3):e1-148. Texto libre en http://www.sciencedirect.com/ science/article/pii/S0735109706012630




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