Management of prosthetic mitral valve thrombosis

Prosthetic mitral valve thrombosis is a lifethreatening complication. Data on complications and outcome are limited. The purpose of this study was to review the clinical experience with the thrombolytic therapy and surgical management of prosthetic mitral valve obstruction in our hospital. Between the January 2001 and April 2005, twelve patients with obstructed prosthetic mitral valve were admitted to our hospital. There were 8 female and 4 male patients ranging in age from14 to 60 years, with a mean age of 34±12 years. In all patients, the diagnosis of prosthetic valve thrombosis was confirmed by echocardiography including transesophageal echocardiography. All patients showed absence or muffering of prosthetic valve sounds. Two of 12 patients received thrombolytic therapy by using streptokinase. In the remaining 10 patients, operations were performed on an emergency basis with median sternotomy and cardiopulmonary bypass techniques using antegrade-retrograde combinated isothermic blood cardioplegia and moderate hypothermia. The principal risk factors of prosthetic valve thrombosis are inadequate anticoagulation or fluctuation in anticoagulation levels. Its treatment is either surgical or with thrombolytics. Although both treatment methods are effective, the latter is gaining favor. However, surgery is often required due to large thrombi and a presence of pannus formation.