PMID- 30693052
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1878-5409 (Electronic)
IS  - 1878-5409 (Linking)
VI  - 19
IP  - 1
DP  - 2019 Jan
TI  - A case of thrombolytic therapy with recombinant tissue plasminogen activator for 
      mechanical valve thrombosis at 9 weeks of pregnancy in a Japanese woman.
PG  - 15-18
LID - 10.1016/j.jccase.2018.08.006 [doi]
AB  - A 29-year-old woman was admitted to our hospital due to diagnosis of pregnancy at 
      5 weeks and a day. She underwent valve replacement with mechanical heart valve 
      (MHV: SJM valve) for congenital mitral valve regurgitation, when 11 years old. 
      Warfarin 4 mg was used for anticoagulation. After admission, warfarin was 
      replaced by unfractionated heparin (UFH). She developed exertional dyspnea at 8 
      weeks of pregnancy. Echocardiogram and fluoroscopy showed an immobile leaflet in 
      the closed position. She was diagnosed with mechanical valve thrombosis. Cardiac 
      surgery or thrombolytic therapy (TT) were treatment options. TT is not 
      established, but is reported to be safer than cardiac surgery. Recently, 
      low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) 
      therapy showed acceptable results. About 2.5 h after an intravenous injection of 
      rt-PA, diastolic rumble improved to the normal range of leaflet. Thereafter, 
      warfarin was restarted and there was no recurrence of symptoms and no abortion. 
      She was readmitted for the scheduled Caesarean section (CS) at 32 weeks of 
      pregnancy, and warfarin was replaced with UFH. At 34 weeks of pregnancy, a baby 
      was delivered by CS. She suffered hemostasis after surgery under the 
      anticoagulation. Postoperative day 31, both mother and a child were healthy and 
      left the hospital. <Learning objective: The coagulation status is activated and 
      the fibrinolytic activity is reduced during pregnancy. Prosthetic valve 
      thrombosis during pregnancy is known as a life-threatening event for mother and 
      fetus. The treatment strategy for this complication is not well established. 
      Low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) 
      therapy showed acceptable results. This case report shows that rt-PA therapy for 
      the prosthetic valve thrombosis in a Japanese pregnancy woman could be an 
      alternative treatment strategy to surgery.>.
FAU - Komatsu, Toshinori
AU  - Komatsu T
AD  - Division of Cardiology, Shinshu University Hospital, Nagano, Japan.
FAU - Motoki, Hirohiko
AU  - Motoki H
AD  - Division of Cardiology, Shinshu University Hospital, Nagano, Japan.
FAU - Kimura, Kazuhiro
AU  - Kimura K
AD  - Division of Cardiology, Shinshu University Hospital, Nagano, Japan.
FAU - Saigusa, Tatsuya
AU  - Saigusa T
AD  - Division of Cardiology, Shinshu University Hospital, Nagano, Japan.
FAU - Ebisawa, Soichiro
AU  - Ebisawa S
AD  - Division of Cardiology, Shinshu University Hospital, Nagano, Japan.
FAU - Yokokawa, Yusuke
AU  - Yokokawa Y
AD  - Division of Obstetrics and Gynecology, Shinshu University Hospital, Nagano, 
      Japan.
FAU - Ando, Hirofumi
AU  - Ando H
AD  - Division of Obstetrics and Gynecology, Shinshu University Hospital, Nagano, 
      Japan.
FAU - Ichino, Takashi
AU  - Ichino T
AD  - Division of Anesthesiology and Resuscitology, Shinshu University Hospital, 
      Nagano, Japan.
FAU - Kuwahara, Koichiro
AU  - Kuwahara K
AD  - Division of Cardiology, Shinshu University Hospital, Nagano, Japan.
LA  - eng
PT  - Case Reports
DEP - 20180917
PL  - Japan
TA  - J Cardiol Cases
JT  - Journal of cardiology cases
JID - 101549579
PMC - PMC6342610
OTO - NOTNLM
OT  - Mechanical valve thrombosis
OT  - Pregnancy
OT  - Recombinant tissue plasminogen activator
EDAT- 2019/01/30 06:00
MHDA- 2019/01/30 06:01
PMCR- 2018/09/17
CRDT- 2019/01/30 06:00
PHST- 2018/05/17 00:00 [received]
PHST- 2018/08/22 00:00 [revised]
PHST- 2018/08/30 00:00 [accepted]
PHST- 2019/01/30 06:00 [entrez]
PHST- 2019/01/30 06:00 [pubmed]
PHST- 2019/01/30 06:01 [medline]
PHST- 2018/09/17 00:00 [pmc-release]
AID - S1878-5409(18)30080-X [pii]
AID - 10.1016/j.jccase.2018.08.006 [doi]
PST - epublish
SO  - J Cardiol Cases. 2018 Sep 17;19(1):15-18. doi: 10.1016/j.jccase.2018.08.006. 
      eCollection 2019 Jan.