Chirurgie Cardiaque/cardiac Surgery Thrombolysis for Prosthetic Valve Thrombosis: a Report of 6 Cases and Review of the Literature

Objectives: To determine the outcome of thrombolysis in patients with Prosthetic valve thrombosis (PVT). Design: A retrospective descriptive study. Setting: The intensive care unit of the National Cardiothoracic centre, Korle-bu Teaching Hospital, Accra, Ghana. Subjects: 5 consecutive patients who were thrombolysed for 6 episodes of prosthetic valve thrombosis. Patients and Methods : Over a 3year period 5 patients underwent a total of 6 thrombolytic sessions. All the patients were symptomatic and diagnosis had been confirmed by echocardiography. Streptokinase was used in 5 of the session. 1.5 million International units (IU) was used in the adults and 750,000IU in the 13 year old. One patient had 2.0 million units of urokinase. The infusion was by the short course thrombolytic method over 90 minutes. Results: There were 6 episodes of thrombosis out of 142 (5.0%) valve replacements during the study period. The mean age was 29.5 + 11.2 years (range 13-48years). The time from insertion of prosthetic valve to thrombosis was 15.5 months (range 1 week – 2 years). The INR was sub-therapeutic in 5 (83.3%) of the patients. Streptokinase was used in 5 (83.3%) and urokinase in 1 (16.7%) of the patients. The overall success was 83.3%. Thombolysis was completely successful in 3 (50.0%) and partially in 2 (33.3%). There was no response to thrombolysis in one patient who died after 14 hours. Conclusion: Thrombosis of prosthetic heart valves is not common from our series. Thrombolysis using streptokinase should be the first line management as it is cheap and relatively safe in the management of such cases.