Trombosis valvular y terapia trombolítica en la era moderna: reporte de un caso

Oswaldo E. Aguilar-Molina; David Prada-Escobar; Jairo A. Gándara-Ricardo; Héctor D. Arroyave- Páramo; Juan M. Senior-Sánchez; Edison Muñoz-Ortiz

doi:10.47487/apcyccv.v2i3.149

Authors

Oswaldo E. Aguilar-Molina Seccion de Cardiologia, Departamento de Medicina Interna, Universidad de Antioquia, Medellin, Colombia. https://orcid.org/0000-0002-0207-1975
David Prada-Escobar Departamento de Anestesiologia y Reanimacion, Universidad de Antioquia, Medellin, Colombia. https://orcid.org/0000-0002-3381-1737
Jairo A. Gandara-Ricardo Seccion de Cardiologia, Departamento de Medicina Interna, Universidad de Antioquia, Medellin, Colombia; Clinica Cardiobstetrica, Unidad Funcional Cardiopulmonar y Vascular Periferica, Hospital Universitario San Vicente Fundacion, Medellin, Colombia. https://orcid.org/0000-0003-0757-0033
Hector D. Arroyave- Paramo Departamento de Anestesiología y Reanimación, Universidad de Antioquia, Medellín, Colombia; Clínica Cardiobstétrica, Unidad Funcional Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Medellín, Colombia. https://orcid.org/0000-0002-7211-8628
Juan M. Senior-Sanchez Sección de Cardiología, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia; Clínica Cardiobstétrica, Unidad Funcional Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Medellín, Colombia. https://orcid.org/0000-0001-8312-7194
Edison Munoz-Ortiz Sección de Cardiología, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Colombia; Clínica Cardiobstétrica, Unidad Funcional Cardiopulmonar y Vascular Periférica, Hospital Universitario San Vicente Fundación, Medellín, Colombia. https://orcid.org/0000-0002-5156-7985

DOI:

https://doi.org/10.47487/apcyccv.v2i3.149

Keywords:

Thrombosis, Heart valve diseases, Thrombolytic therapy, Heart failure, Therapeutics

Abstract

Prosthetic valve thrombosis is a feared complication with an annual incidence ranging between 0.3 to 1.3%. Diagnostic approach is essential for a better prognosis and ultimately determines the chosen therapeutic strategy. Emergent valvular surgery is usually recommended in hemodinamically unstable patients, large thrombus or recurrent embolic episodes. These high-risk conditions are often not the case. Therefore, in many patients the surgical risk is much greater than that of bleeding associated with thrombolytic administration. Ultra-slow infusions have been reported with similar efficacy and lower rates of bleeding complications. We present a case of mitral prosthetic valve thrombosis considered not feasible to surgical management and subsequently treated with an ultra-slow tissue plasminogen activator infusion.

Downloads

Download data is not yet available.

References

Akins CW, Miller DC, Turina MI, Kouchoukos N, Blackstone E, Grunkemeier G, et al. Guidelines for Reporting Mortality and Morbidity After Cardiac Valve Interventions. Ann Thorac Surg. 2008;85(4):1490-1495. doi:10.1016/j.athoracsur.2007.12.082

Laplace G, Lafitte S, Labèque J-N, Perron JM, Baudet E, Deville C, et al. Clinical significance of early thrombosis after prosthetic mitral valve replacement. J Am Coll Cardiol. 2004;43(7):1283-1290. doi:10.1016/j.jacc.2003.09.064

Ozkokeli M, Sensoz Y, Ates M, Ekinci A, Akcar M, Yekeler I. Surgical Treatment of Left-sided Prosthetic Valve Thrombosis. Int Heart J. 2005;46(1):105-111. doi:10.1536/ihj.46.105

Özkan M, Gündüz S, Gürsoy OM, Karakoyun S, Astarcioglu M, Kalçik M, et al. Ultraslow thrombolytic therapy: A novel strategy in the management of PROsthetic MEchanical valve Thrombosis and the prEdictors of outcomE: The Ultra-slow PROMETEE trial. Am Heart J. 2015;170(2):409-418.e1. doi:10.1016/j.ahj.2015.04.025

Roudaut R, Serri K, Lafitte S. Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations. Heart. 2007;93(1):137-142. doi:10.1136/hrt.2005.071183

Castilho FM, De Sousa MR, Mendonça ALP, Ribeiro ALP, Cáceres-Lóriga FM. Thrombolytic therapy or surgery for valve prosthesis thrombosis: systematic review and meta-analysis. J Thromb Haemost. 2014;12(8):1218-1228. doi:10.1111/jth.12577

Karthikeyan G, Senguttuvan NB, Joseph J, Devasenapathy N, Bahl V, Airan B. Urgent surgery compared with fibrinolytic therapy for the treatment of left-sided prosthetic heart valve thrombosis: a systematic review and meta-analysis of observational studies. Eur Heart J. 2013;34(21):1557-1566. doi:10.1093/eurheartj/ehs486

Nishimura RA, Otto CM, Bonow RO, Carabello B, Erwin lll J, Fleisher L, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Vol 135.; 2017. doi:10.1161/CIR.0000000000000503

Baumgartner H, Falk V, Bax J, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2018;39(21):1980-1980. doi:10.1093/eurheartj/ehx636

Özkan M, Gündüz S, Biteker M, Astarcioglu MA, Çevik C, Kaynak E, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: The TROIA trial. JACC Cardiovasc Imaging. 2013;6(2):206-216. doi:10.1016/j.jcmg.2012.10.016

Otto CM, Nishimura RA, Bonow RO. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e35-e71. doi: 10.1161/CIR.0000000000000932

Kumar BM, Justin Paul G, Swaminathan N, Gnanavelu G, Ravishankar G, Kumar N, et al. Assessment of hemodynamic and clinical response in thrombolytic therapy for prosthetic valve thrombosis. Indian Heart J. 2017;69:S6. doi: 10.1016/j.ihj.2017.09.215