JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2000; 35:1874-1880
© 2000 by the American College of Cardiology Foundation
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shapira, Y.
Right arrow Articles by Sagie, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shapira, Y.
Right arrow Articles by Sagie, A.

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{dagger}, Mordehay Vaturi, MD{ddagger}, Avital Porter, MD{ddagger}, Yehuda Adler, MD{ddagger}, Yochai Birnbaum, MD{ddagger}, Boris Strasberg, MD{ddagger}, Samuel Sclarovsky, MD{ddagger} and Alex Sagie, MD*

* Dan Sheingarten Echocardiography Unit, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
{dagger} the Catheterization Laboratory, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
{ddagger} 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.

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




This article has been cited by other articles:


Home page
 ICVTSHome page
J. Almeida, A. Santos, F. Barreiros, M. Garcia, and P. Pinho
Stuck leaflet of bileaflet prosthesis in mitral position - five cases to make us think
Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 379 - 383.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. Laplace, S. Lafitte, J.-N. Labeque, J.-M. Perron, E. Baudet, C. Deville, X. Roques, and R. Roudaut
Clinical significance of early thrombosis after prosthetic mitral valve replacement: A postoperative monocentric study of 680 patients
J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1283 - 1290.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. T. Tong, R. Roudaut, M. Ozkan, A. Sagie, M. S. A. Shahid, S. C. Pontes Jr, F. Carreras, S. E. Girard, S. Arnaout, R. F. Stainback, et al.
Transesophageal echocardiography improves risk assessment of thrombolysis of prosthetic valve thrombosis: results of the international PRO-TEE registry
J. Am. Coll. Cardiol., January 7, 2004; 43(1): 77 - 84.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
P. Montorsi, D. Cavoretto, M. Alimento, M. Muratori, and M. Pepi
Prosthetic Mitral Valve Thrombosis: Can Fluoroscopy Predict the Efficacy of Thrombolytic Treatment?
Circulation, September 9, 2003; 108(90101): II-79 - 84.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. Roudaut, S. t. Lafitte, M.-F. Roudaut, C. Courtault, J.-M. Perron, C. Jais, X. Pillois, P. Coste, and A. DeMaria
Fibrinolysis of mechanical prosthetic valve thrombosis: A single-center study of 127 cases
J. Am. Coll. Cardiol., February 19, 2003; 41(4): 653 - 658.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. S. Alpert
The thrombosed prosthetic valve: Current recommendations based on evidence from the literature,*
J. Am. Coll. Cardiol., February 19, 2003; 41(4): 659 - 660.
[Full Text] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
W. F. Baker Jr
Thrombolytic Therapy
Clinical and Applied Thrombosis/Hemostasis, October 1, 2002; 8(4): 291 - 314.
[PDF]

Home page
 Journal Watch CardiologyHome page
Thrombolysis for Prosthetic Valve Thrombosis
Journal Watch Cardiology, September 1, 2000; 2000(901): 10 - 10.
[Full Text]


HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2000 by the American College of Cardiology Foundation.