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The Role of Thrombolysis in the Management of Left-Sided Prosthetic Valve Thrombosis: A Study of 85 Cases Diagnosed by Transesophageal Echocardiography The efficacy and safety of three treatment modalities - thrombolysis, heparin, and surgery - was compared in a large series of 85 episodes of left-sided prosthetic valve thrombosis (PVT) diagnosed by multiplane transesophageal echocardiography (TEE) in 59 patients. Thrombolysis was used in 43 cases (32 obstructive, 11 non-obstructive PVT), heparin in 22 cases (four obstructive, 18 non-obstructive PVT) and surgery was performed in 20 patients (18 obstructive, two non-obstructive PVT) as primary treatment or following failed thrombolysis or heparin therapy. The success rate of thrombolysis was 84% in obstructive and 91% in non-obstructive PVT; heparin failed in all obstructive cases and in 50% of non-obstructive PVT. Thrombolysis was complicated by stroke or transient ischemic attack in 9%, and recurrence was noted in 22%. Mortality was 30% in the surgical group and 5% in patients treated with thrombolysis; all fatalities belonged to obstructive PVT and all but one to NYHA class IV. Thrombolysis appears to be an acceptable and safe treatment modality in left-sided PVT diagnosed by TEE, especially in severely ill patients, and may be recommended as first-line therapy in both obstructive and non-obstructive cases. |
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