PMID- 22641981
OWN - NLM
STAT- MEDLINE
DCOM- 20120723
LR  - 20191112
IS  - 0001-5385 (Print)
IS  - 0001-5385 (Linking)
VI  - 67
IP  - 2
DP  - 2012 Apr
TI  - Success of delayed thrombolysis for metallic tricuspid valve thrombosis.
PG  - 231-4
AB  - We discuss the case of a 55-year-old woman with a history of gastric ulcer, 
      mechanical tricuspid and mitral valve replacement and a pacemaker for 
      post-operative total heart block. The patient underwent elective pacemaker 
      replacement. She developed a large infra-umbilical rectal sheath haematoma during 
      bridging therapy with low-molecular-weight heparins (LMWH), for which she was 
      treated with angiographic embolisation of the epigastric artery. Subsequently, an 
      intravenous unfractionated heparin (UFH) drip was started. Shortly thereafter, 
      the patient developed severe upper gastrointestinal bleeding, caused by a gastric 
      ulcer with a visible vessel. Anticoagulant therapy was interrupted. On the third 
      day after cessation of the UFH drip, the patient developed thrombosis of the 
      prosthetic tricuspid valve, confirmed by transthoracic echocardiography and 
      cinefluoroscopy. Due to the risk of bleeding (from gastric ulcer and rectus 
      sheath), both thrombolytic therapy and redo surgery were deemed to pose an 
      unacceptable risk. We decided to treat the patient with intravenous heparin and 
      postpone thrombolytic therapy until after healing of the gastric ulcer. At 5 
      weeks after the bleeding event, alteplase was administered, with dissolution of 
      the thrombus and restoration of valve disc motion. No embolic or bleeding 
      complications occurred thereafter and six months after the event, the patient is 
      in excellent general condition.
FAU - Gijsbers, Katrien
AU  - Gijsbers K
AD  - Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, 
      Belgium. katriengijsbers@gmail.com
FAU - Adriaenssens, Tom
AU  - Adriaenssens T
FAU - Herregods, Marie-Christine
AU  - Herregods MC
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Acta Cardiol
JT  - Acta cardiologica
JID - 0370570
RN  - 0 (Fibrinolytic Agents)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - IM
MH  - Cineradiography
MH  - Echocardiography
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage
MH  - Fluoroscopy
MH  - Follow-Up Studies
MH  - Gastrointestinal Hemorrhage/etiology
MH  - Heart Block/therapy
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Humans
MH  - Middle Aged
MH  - Stomach Ulcer/*complications
MH  - *Thrombolytic Therapy/methods
MH  - Thrombosis/diagnosis/drug therapy/*etiology
MH  - Time Factors
MH  - Tissue Plasminogen Activator/administration & dosage
MH  - Treatment Outcome
MH  - *Tricuspid Valve
EDAT- 2012/05/31 06:00
MHDA- 2012/07/24 06:00
CRDT- 2012/05/31 06:00
PHST- 2012/05/31 06:00 [entrez]
PHST- 2012/05/31 06:00 [pubmed]
PHST- 2012/07/24 06:00 [medline]
AID - 10.1080/ac.67.2.2154214 [doi]
PST - ppublish
SO  - Acta Cardiol. 2012 Apr;67(2):231-4. doi: 10.1080/ac.67.2.2154214.