CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
340
AFRICA
Diagnostic assessment of prosthetic mitral
valve thrombosis by real-time three-dimensional
transoesophageal echocardiography and successful
thrombolytic treatment
HUMBERTO MORAIS, TELMO MARTINS, JOSÉ ROBERTO, FIDEL CÁCERES-LÓRIGA
Abstract
Prosthetic valve thrombosis (PVT) is a rare but serious
complication of valve replacement, most often encountered
with mechanical prostheses.The different therapeutic modal-
ities for PVT (fibrinolysis with heparin treatment or surgery)
will largely be influenced by the presence of valvular obstruc-
tion, the valve location (left or right sided), the patient’s
clinical status, the existence of and expertise in therapeutic
modalities at the institution, and the patient’s decision. This
report describes a patient with thrombosis of a prosthetic
mitral valve, which was successfully treated with recombi-
nant streptokinase in a hospital without cardiac surgery. In
this context, the authors present the real-time transoesopha-
geal echocardiographic appearance of this complication, and
give a brief review of the literature.
Keywords:
prosthetic valve thrombosis, fibrinolysis, real-time
three-dimensional transoesophageal echocardiography, transtho-
racic echocardiography, Angola
Submitted 31/7/09, accepted 31/8/10
Cardiovasc J Afr
2011;
22
: 340–342
DOI: 10.5830/CVJA-2010-071
Prosthetic valve thrombosis (PVT) is a non-frequent but serious
complication of cardiac valve replacement, most often encoun-
tered with mechanical prostheses. The significant morbidity and
mortality associated with this condition requires rapid diagnostic
evaluation. However, the diagnosis can be challenging, mainly
because of variable clinical presentations and the degree of
valvular obstruction. Cinefluroscopy (for mechanical valves),
transthoracic (TTE) and transoesophageal echocardiography
(TEE) represent the main diagnostic tools.
1
The different therapeutic modalities for PVT (fibrinolysis
with heparin treatment or surgery) will largely be influenced
by the presence of valvular obstruction, the valve location (left
or right sided), the patient’s clinical status, the existence of and
expertise in therapeutic modalities at the institution, and the
patient’s decision. This report describes a patient with thrombo-
sis of a prosthetic mitral valve, who was treated with recombi-
nant streptokinase in a hospital without cardiac surgery. In this
context we present a review of the literature.
Case report
A 25-year-old black man was admitted to the hospital with a
history of progressive dyspnoea and fatigue in the previous two
weeks. He had a history of heart failure due to severe mitral
regurgitation since 2005. A 31-mm Sorin bicarbonic pros-
thetic valve had been inserted in the mitral position three years
earlier in South Africa. Since then, he had been taking warfarin
and bisoprolol, and had been in NYHA class I. The last TTE
performed a few months previously had revealed normal func-
tion of the prosthetic mitral valve. Two months prior to presenta-
tion he stopped taking warfarin.
On admission, the physical examination revealed a patient
with a supine blood pressure of 110/80 mmHg, a pulse rate of
100 beats/min, a regular rhythm, and elevated jugular venous
pressure. A precordial examination revealed a muffled first heart
sound, a normal second heart sound, and a diastolic rumble at the
apex. No trill was present. The lungs revealed bibasilar crackles.
Departamento de Cardiologia do Hospital Militar Principal/
Instituto Superior, Luanda, Angola
HUMBERTO MORAIS, MD,
TELMO MARTINS, MD
JOSÉ ROBERTO, MD
Institute of Cardiology and Cardiovascular Surgery, Havana,
Cuba
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