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. 2014 Jul-Aug;66(4):427-9.
doi: 10.1016/j.ihj.2014.05.008. Epub 2014 Jun 10.

Percutaneous management of prosthetic valve thrombosis

Vuppaladadhiam Hariram  1
Affiliations

Percutaneous management of prosthetic valve thrombosis

Vuppaladadhiam Hariram. Indian Heart J. 2014 Jul-Aug.

Abstract

Background: Thrombosis of a prosthetic valve is a serious complication in patients with prosthetic heart valves. Thrombolysis is the initial choice of treatment. Patients who do not respond to thrombolysis are subjected to surgery which carries a high risk. We report a case series of 5 patients with prosthetic mitral valve thrombosis who did not respond to thrombolysis and were subjected to percutaneous manipulation of the prosthetic valves successfully and improved.

Methods: Five patients who were diagnosed to have prosthetic mitral valve thrombosis and failed to respond to a minimum of 36 h of thrombolysis (persistent symptoms with increased gradients, abnormal findings on fluoroscopy),were subjected to percutaneous treatment after receiving proper consent. None of them had a visible thrombus on transthoracic echocardiogram. All patients underwent transseptal puncture following which a 6F JR4 guiding catheter was passed into the left atrium. The valve leaflets were repeatedly hit gently under fluoroscopic guidance till they regained their normal mobility.

Results: Mean age was 38.8 years. Average peak and mean gradients prior to the procedure were 38 and 25 and after the procedure were 12 and 6 mm of Hg respectively. All patients had successful recovery of valve motion on fluoroscopy with normalization of gradients and complete resolution of symptoms. None of the patients had any focal neurological deficits, embolic manifestations or bleeding complications.

Conclusions: Percutaneous manipulation of prosthetic valves in selected patients with prosthetic valve thrombosis who do not respond to thrombolytic therapy is feasible and can be used as an alternative to surgery.

Keywords: Failed thrombolysis; Percutaneous manipulation; Prosthetic valve thrombosis.

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Figures

Fig. 1
Fig. 1
Passage of the 6F JR guiding catheter across the prosthetic valve after transseptal puncture.
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