Fibrinolytic therapy was utilized as an alternative to re-do open heart surgery for acute prosthetic mechanical mitral valve thrombosis following inadequate postoperative anticoagulation.
May avoid reoperation in select prosthetic valve thrombosis; hypothesis-generating case report requiring prospective validation.
A 61-year-old woman was referred for chest discomfort 7 days after successful open cholecystectomy. She has had a prosthetic mechanical mitral valve for 10 years and been on warfarin medication since then. Her preoperative cardiac work-up showed good mechanical valve function with optimal prothrombin time international normalized ratio levels. However, anticoagulation was inadequate during the immediate postoperative period, and subsequent echocardiograms revealed a newly developed thrombus with one leaflet fixation. Having an acute thrombus with New York Heart Association functional class I-II and a strong reluctance to re-do open heart surgery, fibrinolytic therapy was performed.
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Lee et al. (2016) studied this question.
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