PMID- 37671250
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230907
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 9
DP  - 2023 Sep
TI  - Dual mechanical valve thrombosis resolution through thrombolytics: a case series.
PG  - ytad399
LID - 10.1093/ehjcr/ytad399 [doi]
LID - ytad399
AB  - BACKGROUND: Prosthetic valve thrombosis (PVT) is a severe complication of 
      mechanical valve replacement. Simultaneous thrombosis of multiple prosthetic 
      valves is rare and is associated with worse outcomes. Treatment options include 
      anticoagulation, thrombolysis, and redo operative valve replacement, with rare 
      reports of adjunctive balloon valvuloplasty. There is limited evidence to guide 
      therapeutic selection, specifically dosing, timing, and duration of thrombolysis. 
      The following case series highlights the importance of successful thrombolytic 
      management in dual PVT with high bleeding risk defined as a coagulopathy with an 
      elevated international normalized ratio greater than 3 and New York Heart 
      Association (NYHA) Class III and IV heart failure. CASE SUMMARY: We describe two 
      patients with concomitant aortic and mitral PVT. Both patients presented in NYHA 
      Class III and IV heart failure with different challenges to surgical treatments 
      including high bleeding risk from coagulopathy and history of multiple prior 
      sternotomies. After multi-disciplinary discussions, both patients underwent a 
      combination of low-dose, slow, or ultra-slow infusion of tissue plasminogen 
      activator, with a resolution of their dual PVT seen on cine-fluoroscopy imaging 
      as freely moving mechanical leaflets and improvement of heart failure symptoms 
      back to baseline NYHA Class II or lower. DISCUSSION: Prosthetic valve thrombosis 
      is a complex medical condition requiring a multi-disciplinary team to evaluate 
      the best course of treatment. A trial of pharmacologic thrombolysis is often the 
      first attempted treatment for obstructive PVT, although surgery is recommended 
      for patients with NYHA IV symptoms, or with contraindications to thrombolysis, 
      including high bleeding risk. However, in patients with high bleeding risk and 
      NYHA Class III and IV heart failure, especially with surgical contraindications, 
      low-dose thrombolytics, with slow or ultra-slow infusions, may still be safe and 
      effective treatment strategies for multi-valve PVT. Further research is needed to 
      guide thrombolysis in multi-valve PVT.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - McGuire, Colin
AU  - McGuire C
AUID- ORCID: 0000-0002-6942-7665
AD  - Department of Medicine, Georgetown University Hospital, Washington, DC, USA.
FAU - Yang, Michael
AU  - Yang M
AD  - Division of Cardiology, Medstar Washington Hospital Center, 110 Irving St., NW, 
      Washington, DC, USA.
FAU - Papolos, Alexander
AU  - Papolos A
AD  - Division of Cardiology, Medstar Washington Hospital Center, 110 Irving St., NW, 
      Washington, DC, USA.
AD  - Department of Critical Care Medicine, Medstar Washington Hospital Center, 110 
      Irving St., NW, Washington, DC, USA.
FAU - Rogers, Toby
AU  - Rogers T
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
AD  - Cardiovascular Intervention Program, Division of Intramural Research, National 
      Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 
      USA.
FAU - Kenigsberg, Benjamin
AU  - Kenigsberg B
AUID- ORCID: 0000-0002-0146-9535
AD  - Division of Cardiology, Medstar Washington Hospital Center, 110 Irving St., NW, 
      Washington, DC, USA.
AD  - Department of Critical Care Medicine, Medstar Washington Hospital Center, 110 
      Irving St., NW, Washington, DC, USA.
LA  - eng
PT  - Case Reports
DEP - 20230819
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC10476460
OTO - NOTNLM
OT  - Case reports
OT  - Heart valve prosthesis
OT  - Thrombolytic therapy
OT  - Thrombosis
OT  - Valvular heart Disease
COIS- Conflict of interest: T.R.: Consultant and Physician Proctor: Medtronic, Edwards 
      Lifesciences, Boston Scientific; Advisory Board, Medtronic; Equity Interest, 
      Transmural Systems.
EDAT- 2023/09/06 06:42
MHDA- 2023/09/06 06:43
PMCR- 2023/08/19
CRDT- 2023/09/06 03:55
PHST- 2022/08/10 00:00 [received]
PHST- 2023/08/01 00:00 [revised]
PHST- 2023/08/15 00:00 [accepted]
PHST- 2023/09/06 06:43 [medline]
PHST- 2023/09/06 06:42 [pubmed]
PHST- 2023/09/06 03:55 [entrez]
PHST- 2023/08/19 00:00 [pmc-release]
AID - ytad399 [pii]
AID - 10.1093/ehjcr/ytad399 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Aug 19;7(9):ytad399. doi: 10.1093/ehjcr/ytad399. 
      eCollection 2023 Sep.