CLINICAL STUDIES
Thrombolysis is an effective and safe therapy in stuck bileaflet mitral valves in the absence of high-risk thrombi
Yaron Shapira, MD*,
Itzhak Herz, MD ,
Mordehay Vaturi, MD ,
Avital Porter, MD,
Yehuda Adler, MD,
Yochai Birnbaum, MD,
Boris Strasberg, MD,
Samuel Sclarovsky, MD and
Alex Sagie, MD*
* Dan Sheingarten Echocardiography Unit, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
the Catheterization Laboratory, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
the Coronary Intensive Care Unit, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
Manuscript received June 14, 1999;
revised manuscript received December 10, 1999,
accepted February 9, 2000.
Reprint requests and correspondence: Dr. Alex Sagie, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, 49100 Israel
OBJECTIVES
We sought to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves in the absence of high-risk thrombi.
BACKGROUND
Current recommendations for the thrombolytic treatment of stuck prosthetic mitral valves are partially based on older valve models and inclusion of patients in whom high-risk thrombi were either ignored or not sought for. The feasibility and safety of thrombolysis in bileaflet models may be affected by the predilection of thrombi to catch the leaflet hinge.
METHODS
We studied 12 consecutive patients (men/women = 5/7, age 58.8 ± 14.9 years) who experienced one or more episodes of stuck bileaflet mitral valve over a 33-month period and received thrombolytic therapy with streptokinase, urokinase or tissue-type plasminogen activator. Transesophageal echocardiography was performed in all patients. Patients with mobile or large (>5 mm) thrombi were excluded. Functional class at initial episode was I–II in 4 patients (33.3%) and III–IV in 8 patients (66.6%).
RESULTS
Patients receiving thrombolytic therapy achieved an overall 83.3% freedom from a repeat operation or major complications (95% confidence interval 51.6–97.9%). Minor bleeding occurred in three patients (25%) and allergic reaction in one (8.3%). Transient vague neurologic complaints, without subjective findings, occurred in four patients (33.3%). Three patients had one or more relapses within 5.2 ± 3.1 months from the previous episode, and readministration of thrombolytics was successful.
CONCLUSIONS
In clinically stable patients with stuck bileaflet mitral valves and no high-risk thrombi, thrombolysis is highly successful and safe, both in the primary episode and in recurrence. The best thrombolytic regimen is yet to be established.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft | | FC | = functional class | | INR | = international normalized ratio | | NYHA | = New York Heart Association | | STK | = streptokinase | | TEE | = transesophageal echocardiography | | tPA | = tissue-type plasminogen activator | | TTE | = transthoracic echocardiography | | UK | = urokinase |
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