Thrombolytic treatment for acute prosthetic valve thrombosis: Is it better than surgery?

Prosthetic valve thrombosis (PVT) is a rare but often lethal complication of valve replacement. Despite advances in surgical techniques, surgical mortality remains high and emergent cardiac surgery is not widely available. Herein, we present the case of an acute PVT successfully treated with thrombolytic therapy. A 48-year-old female presented to the emergency department with acute onset of shortness of breath. Her medical history was remarkable for mitral valve replacement at the age of 42 years. Her symptoms began 4 h before, when she suddenly presented severe resting dyspnea. At arrival she showed pulmonary edema and hemodynamic instability. Echocardiography showed a prosthetic mitral valve stuck in a semi-closed position with a gradient of 39 mm Hg. Treatment was started with alteplase and the patient presented marked clinical improvement in subsequent hours. Recent evidence suggests that thrombolysis could be elected as the first choice of treatment in patients with left-side PVT because of the effectiveness, safety profile, availability, and low cost. This case illustrates the importance of prompt diagnosis and treatment and proposes thrombolytic therapy for PVT as an option at least as efficient as and far more accessible than surgery. <Learning objective: This case illustrates the importance of prompt diagnosis of prosthetic valve thrombosis (PVT) and proposes thrombolytic therapy for PVT as an option at least as efficient as and far more accessible than surgery.>.