Treatment of left-sided prosthetic valve thrombosis: thrombolysis or surgery?

Although, traditionally, surgery has been the treatment of choice for left-sided prosthetic valve thrombosis (PVT), there are significant risks associated with re-do surgery. Thrombolysis is an alternative to surgery and has a success rate in excess of 80%, but is associated with an -10% risk of systemic embolism and a 7% mortality rate. Guidelines for the use of thrombolytic therapy for PVT were produced using data acquired from older valves, and largely without the use of transesophageal echocardiography (TEE). Data from more recent studies suggest that thrombolysis should be regarded as first-line therapy for PVT in all NYHA classes. The use of TEE is recommended to visualize thrombus in suspected cases.