BACKGROUND: Stuck mechanical heart valves had a debate about the management plan. There is debate regarding the type, dose, and rate of administration of various thrombolytic agents. We report a case with successful thrombolysis using an ultraslow regimen. CASE SUMMARY: A 43-year-old female with a history of aortic valve (AV) and mitral valve replacement (bi-leaflet metallic valves), and tricuspid valve repair (MINI band) at October 2017. Physical examination showed normal metallic first heart sound and weak metallic second heart sound. Laboratory investigations were normal except low INR, hematocrit, and hemoglobin level (9 gm/L due to iron deficiency anemia). Transthoracic echocardiogram (TTE) and Transoesophageal echocardiogram (TEE) confirmed stuck aortic valve leaflet, with a high mean pressure gradient across prosthetic AV (34 mmHg). The mechanical mitral valve was working well. Fluoroscopy showed stuck one of the AV leaflets in a closed position. The treating physician decided to give her the chance for thrombolytic therapy. This case was treated with ultraslow thrombolytic therapy (Alteplase, 1 mg, every hour) with follow up transthoracic echocardiogram every 24 h to check the pressure gradient on the AV. She was young, asymptomatic, and hemodynamically stable. After 48 h of Alteplase, the stuck leaflet was released. The mean pressure gradient dropped to 16 mmHg. DISCUSSION: Ultraslow thrombolytic regimen advised to be tried in stuck mechanical valves and hemodynamically stable patients.
BACKGROUND: Stuck mechanical heart valves had a debate about the management plan. There is debate regarding the type, dose, and rate of administration of various thrombolytic agents. We report a case with successful thrombolysis using an ultraslow regimen. CASE SUMMARY: A 43-year-old female with a history of aortic valve (AV) and mitral valve replacement (bi-leaflet metallic valves), and tricuspid valve repair (MINI band) at October 2017. Physical examination showed normal metallic first heart sound and weak metallic second heart sound. Laboratory investigations were normal except low INR, hematocrit, and hemoglobin level (9 gm/L due to iron deficiency anemia). Transthoracic echocardiogram (TTE) and Transoesophageal echocardiogram (TEE) confirmed stuck aortic valve leaflet, with a high mean pressure gradient across prosthetic AV (34 mmHg). The mechanical mitral valve was working well. Fluoroscopy showed stuck one of the AV leaflets in a closed position. The treating physician decided to give her the chance for thrombolytic therapy. This case was treated with ultraslow thrombolytic therapy (Alteplase, 1 mg, every hour) with follow up transthoracic echocardiogram every 24 h to check the pressure gradient on the AV. She was young, asymptomatic, and hemodynamically stable. After 48 h of Alteplase, the stuck leaflet was released. The mean pressure gradient dropped to 16 mmHg. DISCUSSION: Ultraslow thrombolytic regimen advised to be tried in stuck mechanical valves and hemodynamically stable patients.
Authors: K Hammermeister; G K Sethi; W G Henderson; F L Grover; C Oprian; S H Rahimtoola Journal: J Am Coll Cardiol Date: 2000-10 Impact factor: 24.094
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Authors: Mehmet Özkan; Sabahattin Gündüz; Ozan Mustafa Gürsoy; Süleyman Karakoyun; Mehmet Ali Astarcıoğlu; Macit Kalçık; Ahmet Çağrı Aykan; Beytullah Çakal; Zübeyde Bayram; Ali Emrah Oğuz; Emre Ertürk; Mahmut Yesin; Tayyar Gökdeniz; Nilüfer Ekşi Duran; Mustafa Yıldız; Ali Metin Esen Journal: Am Heart J Date: 2015-05-02 Impact factor: 4.749
Authors: Mehmet Özkan; Sabahattin Gündüz; Murat Biteker; Mehmet Ali Astarcioglu; Cihan Çevik; Evren Kaynak; Mustafa Yıldız; Emrah Oğuz; Ahmet Çağrı Aykan; Emre Ertürk; Yusuf Karavelioğlu; Tayyar Gökdeniz; Hasan Kaya; Ozan Mustafa Gürsoy; Beytullah Çakal; Süleyman Karakoyun; Nilüfer Duran; Nihal Özdemir Journal: JACC Cardiovasc Imaging Date: 2013-02