Fibrinolytic treatment of thrombosis of prosthetic heart valves

Eleven episodes of valvular prosthetic thrombosis occurred in 10 patients and were treated by fibrinolytic drugs. The diagnosis of valvular thrombosis was reached on the basis of clinical symptoms (acute pulmonary edema, shock, thromboembolic accidents), auscultation (disappearance of prosthetic valve click and appearance of a murmur), echocardiogram and/or cinefluorography. The treatment administered consisted of: urokinase (UK) 4500 i.u./kg/h for 12 h (five times), streptokinase (SK) 2 000 000 i.u. for 10 h (four times), UK followed by SK at the same dose (twice). The results were followed clinically and by the same methods as were used for diagnosis. Immediate complete regression of all clinical, echocardiographic and cinematographic signs was seen in seven cases. These cases did not undergo cardiac surgery. In two cases, where clear clinical improvement was obtained whilst both the echo and cinefluorography showed persistent valve dysfunction, the patients were re-operated upon. In one case, fibrinolytic treatment was totally ineffective and the patient underwent emergency valve replacement. SK was more effective from the biological point of view, but the clinical results obtained were identical with both drugs at the prescribed dose. There were no hemorrhagic complications, but emboli from the thrombolysis occurred in three patients. The procedure to be adopted in case of complete regression by fibrinolytic drugs is discussed: automatic cardiac surgery or more medical supervision.