PMID- 14715187
OWN - NLM
STAT- MEDLINE
DCOM- 20040203
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 43
IP  - 1
DP  - 2004 Jan 7
TI  - Transesophageal echocardiography improves risk assessment of thrombolysis of 
      prosthetic valve thrombosis: results of the international PRO-TEE registry.
PG  - 77-84
AB  - OBJECTIVES: The goal of this study was to evaluate whether quantitation of 
      thrombus burden with transesophageal echocardiography (TEE) can help 
      risk-stratify patients undergoing thrombolysis of prosthetic valve thrombosis 
      (PVT). BACKGROUND: Thrombolytic therapy of PVT has an unpredictable risk of 
      embolization and complications. METHODS: An international registry of patients 
      with suspected PVT undergoing two-dimensional/Doppler and TEE before thrombolysis 
      was established. All TEE studies were reviewed and quantitated by a single 
      observer blinded to all data. RESULTS: From 1985 to 2001, 107 patients (71 
      females; age 24 to 86 years) from 14 centers (6 in the U.S.) were identified. The 
      majority of cases involved the mitral valve (79 mitral, 13 aortic, and 15 
      tricuspid). Hemodynamic success rate was achieved in 85% and was similar across 
      valves. Overall complications were observed in 17.8%, and death in 5.6%. 
      Predictors of complications were: New York Heart Association (NYHA) functional 
      class, presence of shock, sinus tachycardia, hypotension, previous history of 
      stroke, thrombus extension beyond the valve ring, and thrombus area. Multivariate 
      analysis demonstrated that two variables were independent predictors of 
      complications: thrombus area by TEE (odds ratio [OR] 2.41 per 1 cm2 increment, 
      95% confidence interval [CI] 1.12 to 5.19) and prior history of stroke (OR 4.55, 
      95% CI 1.35 to 15.38). A thrombus area <0.8 cm2 identified patients at lower risk 
      for complications from thrombolysis, irrespective of NYHA functional class. 
      CONCLUSIONS: In PVT, the thrombus size imaged with TEE is a significant 
      independent predictor of outcome. Transesophageal echocardiography can identify 
      low-risk groups for thrombolysis irrespective of symptom severity and is 
      therefore recommended in the management of prosthetic valve thrombosis.
FAU - Tong, Ann T
AU  - Tong AT
AD  - Baylor College of Medicine, Houston, Texas, USA.
FAU - Roudaut, Raymond
AU  - Roudaut R
FAU - Ozkan, Mehmet
AU  - Ozkan M
FAU - Sagie, Alex
AU  - Sagie A
FAU - Shahid, Maie S A
AU  - Shahid MS
FAU - Pontes Junior, Sergio C
AU  - Pontes Junior SC
FAU - Carreras, Francesc
AU  - Carreras F
FAU - Girard, Steven E
AU  - Girard SE
FAU - Arnaout, Samir
AU  - Arnaout S
FAU - Stainback, Raymond F
AU  - Stainback RF
FAU - Thadhani, Ravi
AU  - Thadhani R
FAU - Zoghbi, William A
AU  - Zoghbi WA
CN  - Prosthetic Valve Thrombolysis-Role of Transesophageal Echocardiography (PRO-TEE) 
      Registry Investigators
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2005 Jan 18;45(2):325; author reply 326. PMID: 15653040
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Echocardiography, Transesophageal
MH  - Female
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Registries
MH  - Risk Assessment
MH  - *Thrombolytic Therapy/adverse effects
MH  - Thrombosis/*diagnostic imaging/*drug therapy/etiology
EDAT- 2004/01/13 05:00
MHDA- 2004/02/05 05:00
CRDT- 2004/01/13 05:00
PHST- 2004/01/13 05:00 [pubmed]
PHST- 2004/02/05 05:00 [medline]
PHST- 2004/01/13 05:00 [entrez]
AID - S0735109703013639 [pii]
AID - 10.1016/j.jacc.2003.08.028 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2004 Jan 7;43(1):77-84. doi: 10.1016/j.jacc.2003.08.028.