Repeated Prosthetic Valve Thrombosis—A Case Report Illustrating the Need for Consensus in a Time Sensitive Therapy

Abstract

Of patients with rheumatic heart disease in Australia, 88.8% are Indigenous and often in remote or under-resourced communities [ [1] Katzenellenbogen J.M. Bond-Smith D. Seth R.J. Dempsey K. Cannon J. Stacey I. et al. Contemporary incidence and prevalence of rheumatic fever and rheumatic heart disease in Australia using linked data: the case for policy change. J Am Heart Assoc. 2020; 9: e016851 Crossref PubMed Scopus (33) Google Scholar ]. Surgical intervention remains an important treatment but survival and freedom from complications for Indigenous patients is reportedly lower than in similar cohorts from developing countries [ [2] Carapetis J.R. Powers J.R. Currie B.J. Sangster J.F. Begg A. Fisher D.A. et al. Outcomes of cardiac valve replacement for rheumatic heart disease in aboriginal Australians. Asia Pacific Heart J. 1999; 8: 138-147 Abstract Full Text PDF Scopus (20) Google Scholar ]. Prosthetic valve thrombosis is a rare but serious complication and thrombolysis is known to be successful in the Indigenous population [ [3] Milne O. Barthwal R. Agahari I. Ilton M. Kangaharan N. Management and outcomes of prosthetic valve thrombosis. An Australian case series from the Northern Territory. Heart Lung Circ. 2020; 29: 469-474 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. There is, however, no consensus as to which thrombolytic therapy regimen to prescribe.