SHM Converge Scientific Abstract ePoster Gallery-Successful Thrombolysis of an Obstructive Bio-Prosthetic Mitral Valvular Thrombus Using Tissue Plasminogen Activator: A Case Report.

Successful Thrombolysis of an Obstructive Bio-Prosthetic Mitral Valvular Thrombus Using Tissue Plasminogen Activator: A Case Report.

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This case report describes an 82-year-old man who developed acute heart failure symptoms six weeks after bioprosthetic mitral valve replacement. He presented with sudden exertional dyspnea and orthopnea, hypotension, elevated BNP and troponin, and chest X-ray findings consistent with pulmonary edema. Initial treatment for congestive heart failure was started, but transesophageal echocardiogram revealed the true cause: a thrombus causing obstruction of a bioprosthetic mitral valve leaflet, with severe mitral stenosis and regurgitation and a markedly elevated valve gradient.<br /><br />Because surgery carries significant risk and BPVT treatment data are limited, the team chose thrombolysis. The patient received low-dose slow-infusion tissue plasminogen activator (tPA, alteplase) for six hours, repeated once more for another six hours. Follow-up TEE showed complete resolution of the thrombus, restoration of leaflet mobility, and elimination of residual stenosis or regurgitation. The mean mitral gradient improved from 23 mm Hg to 8 mm Hg, and the patient’s symptoms improved dramatically. He was then transitioned to warfarin with heparin bridging.<br /><br />The authors conclude that tPA thrombolysis can be an effective and safe treatment option for obstructive bioprosthetic valve thrombosis and should be considered before surgical valve replacement, potentially reducing patient burden and healthcare costs. However, they note that randomized controlled trials comparing thrombolysis with surgery are lacking.

Asset Subtitle

Shivaraj Nagalli

Meta Tag

Author List Nidhi Shankar Kikkeri, Shivaraj Nagalli

Category Clinical Vignettes

Concept Bioprosthetic Mitral Valve Thrombosis

Concept Obstructive Valve Thrombosis

Concept Prosthetic Valve Thrombosis

Concept Echocardiography

Concept IV Alteplase

Distinguished Non-Finalist

Presenter Organization Brookwood Baptist Health

Presenting Author Shivaraj Nagalli

Track Adult

Keywords

bioprosthetic mitral valve

valve thrombosis

acute heart failure

thrombolysis

tPA alteplase

transesophageal echocardiogram

mitral stenosis

mitral regurgitation

warfarin bridging

pulmonary edema

Bioprosthetic Mitral Valve Thrombosis

Obstructive Valve Thrombosis

Prosthetic Valve Thrombosis

Echocardiography

IV Alteplase