Successful fibrinolytic treatment of prosthetic heart valve thrombosis using streptokinase

Objectives: This study aims to evaluate the clinical outcome of fibrinolytic treatment of prosthetic valve thrombosis (PVT) with 'streptokinase' as a first line treatment for these cases. Methods: The study group was 20 consecutive patients (10 females) diagnosed with PVT. The protocol for streptokinase administration was either accelerated (intravenous infusion of 0.5 million IU over 30 minutes followed by 0.15 million IU/h) or conventional (intravenous infusion of 0.25 million IU over 30 minutes followed by 0.15 million IU/h). Success of fibrinolytic therapy was defined as complete restoration of valve function in the presence or absence of complications. Results: Eighteen patients (90%) had mitral PVT and two (10%) had aortic PVT. Thrombolytic therapy with streptokinase was successful in all but one case, with a total mortality of four cases (20%). In PVT episodes, before streptokinase therapy, the prosthetic valve areas (in all cases, mitral and aortic positions) were 0.82 +/- 0.21, 0.83 +/- 0.21, and 0.73 +/- 0.18 cm(2); and the peak and mean transvalvular gradients were 38.7 +/- 16.7 and 25.4 +/- 8.7, 34.1 +/- 8.8 and 23.2 +/- 5.4, and 80.0 +/- 14.1 and 45.0 +/- 7.1 mmHg, respectively. After streptokinase therapy, the prosthetic valve area and peak and mean transvalvular gradients improved significantly (for all cases, mitral and aortic positions: valve area 2.17 +/- 0.58, 2.21 +/- 0.61, and 1.85 +/- 0.07 cm(2), peak gradient 18.7 +/- 11.0, 16.4 +/- 7.7, and 39.0 +/- 18.4, and mean gradient 9.6 +/- 7.1, 8.2 +/- 5.3, and 22.0 +/- 11.3 mmHg, respectively; paired t-test, P<0.001 for pre-versus post-streptokinase infusion for all variables). Conclusion: Fibrinolytic therapy using streptokinase was an effective therapeutic strategy for the management of PVT and is a reasonable alternative to surgery.