Key result
Catheter-directed low-dose alteplase safely resolves prosthetic valve thrombosis within 48 hours in a toddler.
Why the study?
Mechanical mitral valve thrombosis in early childhood is rare and its acute management is challenging.
Does catheter-directed continuous low-dose alteplase safely resolve mechanical mitral valve thrombosis in a pediatric patient?
Case Report (n=1)
Does catheter-directed continuous low-dose alteplase safely resolve mechanical mitral valve thrombosis in a pediatric patient?
Catheter-directed, continuous low-dose alteplase safely restored mechanical prosthetic mitral valve function without hemorrhagic complications in a highly surgical-risk pediatric patient.
May support catheter-directed thrombolysis in select pediatric mechanical valve thrombosis; leaves open need for prospective validation.
BACKGROUND: Mechanical mitral valve thrombosis in early childhood is rare, and its acute management is challenging. CASE SUMMARY: A 2-year-old girl with Shone complex and multiple prior mitral valvuloplasties developed obstructive thrombosis 20 days after inverted Saint-Jude mechanical valve implantation (mean mitral gradient 26.75 mm Hg). Given multiple previous sternotomies and hemodynamic stability, catheter-directed, continuous low-dose alteplase was infused into the left atrium with a catheter positioned into the left inferior pulmonary vein (0.045 mg/kg/h; then 0.1 mg/kg/h) under uninterrupted heparinization. Leaflet mobility improved within 48 hours, with complete thrombus resolution and no hemorrhagic complications. DISCUSSION: This case illustrates that continuous, low-dose local thrombolysis with alteplase may be a safe and effective alternative for mechanical mitral valve thrombosis in pediatric patients, especially those with elevated surgical risks. TAKE-HOME MESSAGE: Catheter-directed, continuous low-dose alteplase can promptly restore prosthetic mitral valve function in stable pediatric patients, provided strict monitoring and anticoagulation stewardship.
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Bossierre et al. (2026) conducted a case report in Mechanical mitral valve thrombosis (n=1). Catheter-directed continuous low-dose alteplase was evaluated on Leaflet mobility, thrombus resolution, and hemorrhagic complications. Catheter-directed, continuous low-dose alteplase successfully restored leaflet mobility and achieved complete thrombus resolution within 48 hours without hemorrhagic complications in a 2-year-old.
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