Localized left atrial administration of tPA for the treatment of mechanical mitral valve thrombosis.

Prosthetic valve thrombosis is a dangerous and unfortunately not uncommon medical situation, often seen as a medical emergency. Patients with previously unseen and more confounding medical problems are presenting, making the decision regarding therapeutic options even more complicated. In this case report, we describe a complicated patient with mechanical mitral valve prosthesis placed secondary to rheumatic heart disease, with multiple co-morbidities including severe left ventricular dysfunction, permanent atrial fibrillation, left femoral deep vein thrombosis, and non-sustained ventricular tachycardia, who presented with acute valve thrombosis. The patient' history of hemorrhagic stroke and multiple acute ischemic strokes represented an absolute contraindication to more conventional forms of therapy such as intravenous systemic thrombolytics. In the following case report, we present an unprecedented approach to prosthetic valve thrombosis in this seemingly no-option patient. (c) 2008 Wiley-Liss, Inc.