Thrombolysis in left mechanical prosthetic heart valve obstruction by thrombus. Following and results

Obstruction of the left mechanical heart valve by a thrombus is a serious complication. The factors associated with mortality are functional class, type of valve prosthesis and emergency surgery. Thrombolysis represents a therapeutic option to cardiac surgery. The aim of this investigation was to analyze the role of thrombolysis in the management of thrombus-obstructed left mechanical heart valve. Twenty-two consecutive cases undergoing thrombolysis at the Cardiology Hospital of the Siglo XXI National Medical Center were studied under two different circumstances: with acute pulmonary edema and state of shock in functional class IV and with functional class I-II. Clinical and echocardiographic monitoring and fluoroscopy were performed. The response was satisfactory in 56 % of the patients and there were complications in 69 % of the cases. During the follow-up, recurrence of symptoms occurred in 25 % of the patients, 5-year actuarial survival in 75 % and thromboembolic events-free survival in 37 %. Mortality was 12 %. Thrombolysis is a management alternative in patients with thrombus-obstructed left mechanical heart valve; however, this therapeutic option must be choosen according to clinical circumstances and echocardiographic, hemodynamic or fluoroscopic findings in the patients.