A case series of prosthetic heart valve thrombosis-derived coronary embolism.

Coronary thromboembolism is a rare cause of acute coronary syndromes (ACS). The information regarding ACS in patients with prosthetic heart valves is scarce and based mainly on case reports. Although plaque rupture is the most common cause of acute myocardial infarction, coronary embolism (CE) is not a rare cause of acute myocardial infarction. There is no consensus regarding the treatment in such a situation. We present three cases of prosthetic valve thrombosis complicated with CE causing non-ST elevation ACS, who were successfully treated with thrombolytic therapy (TT). We administered low-dose (25 mg), slow-infusion (6 hours) tissue plasminogen activator (t-PA), which was shown to be safe and effective in our group in a large study. The patients benefited from TT with respect to the coronary flow, as shown by the lysis of thrombi in all three patients on coronary angiogram.