Abstract
Objective:To evaluate the outcome of thrombolysis in patients of prosthetic valve thrombosis.Methods:This retrospective analysis was conducted on data of 84 patients of prosthetic valve thrombosis who presented to emergency room of Faisalabad Institute of Cardiology between July 2017 to December 2019. The diagnosis of prosthetic valve thrombosis was based on clinical suspicion and bed side transthoracic echocardiography done by a consultant cardiologist. Fluoroscopy was done to confirm the diagnosis by observing immobile valve leaflet. The confirmed patients were then treated in emergency with streptokinase after taking an informed consent. Quantitative variables like age were summarized by mean and standard deviation. Qualitative variables like gender, successful thrombolysis, stroke, major bleeding, mortality or re-do surgery were summarized by frequency and percentage.Results:Mean age was 29 ± 6.36, years and there were more female patients (n=43, 51.25%) as compared to males (n=41, 48.8%). Among the 66 surviving patients thrombolysis was successful without any complications in 56 patients (66.7%). Thrombolysis was successful with minor complications in six patients (7.1%) and it failed to produce desired results in four patients (4.8%). In this study 18 (21.4%) patients died. The common complications included minor bleeding in four patients (4.8%) and major bleeding in 10 patients (12.0 %).Conclusion:Thrombolysis produces reasonable success rate in cases of prosthetic valve thrombosis who are in functional class I or II. However, it has very high mortality rate in patients presenting with functional class III and IV.
Highlights
Prosthetic valves used for better quality of life in patients having valvular heart disease can have implications on life later on in terms of complications
After approval from hospital Ethical Committee of Faisalabad Institute of Cardiology (# 012020/DME/FIC/FSD dated 11-07-2020), this retrospective analysis of database was conducted at Faisalabad Institute of Cardiology (FIC), including patients who underwent thrombolysis for prosthetic valve thrombosis from July 2017 to December 2019
A total of 84 patients presented with 1st episode of prosthetic valve thrombosis and underwent the procedure
Summary
Prosthetic valves used for better quality of life in patients having valvular heart disease can have implications on life later on in terms of complications. The incidence of mechanical valve thrombosis is estimated at 0.3% to 1.3% per patient-year in developed countries, but as high as 6% per patient-year in developing countries.[1] In developing country like India, left-sided prosthetic valve thrombosis is noted to be 6.1% of patients within six months of valve replacement surgery.[2] The main cause of this life-threatening complication is inadequate anticoagulant therapy as the meta-analysis of various studies show that incidence of thromboembolism was increased if warfarin was not taken and in such cases antiplatelet therapy fails to prevent it.[3] Clinical suspicion of valve thrombosis must be raised when a patient having prosthetic valve presents with embolism, dyspnea, arrhythmias, or cardiogenic shock.[4] Factors predisposing to thrombus formation are endothelial, hemodynamic and hemostatic Hemodynamic factors include both hemodynamic characteristics of the prosthesis, as well as overall cardiac hemodynamic status. Localized regions of turbulent flow can develop and lead to stasis and thrombus formation
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