Thrombolytics and left-sided prosthetic valve thrombosis. A case report.

Prosthetic valve thrombosis is a well-known condition. Because surgical treatment of prosthetic valve thrombosis is associated with a high mortality rate, the use of thrombolysis as therapy for this condition has gained popularity in recent years. In this article, we discuss the cases of 3 patients who presented to our institution with left-sided prosthetic valve thrombosis between 1994 and 1997. All 3 patients presented with New York Heart Association functional class III or IV symptoms, and all were successfully treated with urokinase. The use of thrombolytic therapy for left-sided prosthetic valve thrombosis is associated with low mortality rates, and therefore is an attractive alternative to valve replacement or thrombectomy. However, the risk of embolic and hemorrhagic complications precludes the use of thrombolysis in patients with large thrombi and in those with New York Heart Association functional class I and II symptoms; for these patients, the risk associated with thrombolysis exceeds surgical mortality rates.