Mechanical aortic valve thrombosis with severe valvular dysfunction treated with multiple rounds of thrombolysis

Abstract

Mechanical aortic valve thrombosis is a rare but serious prosthesis complication. The annual rate of prosthetic mechanical valves ranges from 0.1% to 5.7% with even higher rate in patient not adherent to anticoagulation therapy.1 Diagnosis can be made by examination, TEE and fluoroscopy; we used the latter modality to assess tPA treatment effect.2 Treatment is either surgery or thrombolysis based on thrombus size and presence of obstruction.3 The major risk of fibrinolytic treatment is bleeding and systemic emboli, including stroke. Our case is unique in that we demonstrate safe use of three rounds of tPA. Fortunately, our patient did not have any immediate complications perhaps because of small thrombus size. We performed extensive education about compliance and planned for close follow-up to avoid future catastrophic events in this young patient.