Document Detail


Prosthetic valve obstruction: thrombolysis versus operation.
MedLine Citation:
PMID:  8311597     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
An acute obstruction is a life-threatening complication of mechanical valve prostheses, and is caused by the formation of fresh clot or fibrous tissue overgrowth, or both. Accurate selection of the most appropriate treatment for a particular patient is mandatory. From January 1991 to July 1992, 28 cases of prosthetic thrombosis were managed. Twenty patients underwent surgical treatment, with one operative death, and 8 patients were treated with thrombolysis using recombinant tissue-type plasminogen activator (rt-PA). The criteria for using thrombolysis were (1) the recent onset of symptoms, (2) transesophageal echocardiographic evidence of clots on the valve or cardiac chambers, and (3) preserved disc excursions. All patients who underwent thrombolysis had mechanical valves (two bileaflets, four tilting discs, and two ball valves); seven valves were in the mitral position and one was in the aortic. Symptoms of obstruction consisted of cardiac failure in 6 cases or thromboembolism in 5, or both. The mean interval between the onset of symptoms and the initiation of thrombolysis was 81 +/- 65 hours. After infusion of the rt-PA, normal valve function was restored in all patients, as documented by transesophageal echocardiography. No deaths or neurologic complications occurred; there was one episode of minor peripheral embolism. Thrombolysis using rt-PA may be the appropriate treatment in patients with primary thrombosis of mechanical valves, thereby avoiding the operation-related risks.
Authors:
N Vitale; A Renzulli; F Cerasuolo; A Caruso; M Festa; L de Luca; M Cotrufo
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  57     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-03-17     Completed Date:  1994-03-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  365-70     Citation Subset:  AIM; IM    
Affiliation:
Institute of Cardiac Surgery, Medical School, Monaldi Hospital, Second University of Naples, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Echocardiography, Transesophageal
Evaluation Studies as Topic
Female
Heart Valve Prosthesis*
Humans
Length of Stay
Male
Middle Aged
Reoperation
Thrombosis / surgery,  therapy*,  ultrasonography
Tissue Plasminogen Activator
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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