[The role of transesophageal echocardiography in the fibrinolytic treatment of thrombosis on the artificial mitral valve].

Unlabelled: Fibrinolytic treatment of mitral mechanical prosthetic valve thrombosis is still controversial. This treatment can only be justified if the incidence and severity of complications is relatively low compared to the expected success-rate. The purpose of this study was to assess the role of transesophageal echocardiography (TEE) in the selection of patients optimally suitable for fibrinolytic therapy. Five patients are reported in whom multiplane TEE revealed mitral prosthetic valve thrombosis. Two patients presented with valve obstruction, one patient with partial obstruction and earlier embolism, one with recent peripheral embolism and in 1 patient the thrombus was an unexpected finding on routine check-up. The oldest thrombus was first seen 5 months before fibrinolysis. There was no left atrial thrombus in any of patients. The thrombus was dissolved in all cases by Streptokinase given in a 200,000 unit bolus, followed by 100,000 unit per hour within 13-72 hours. The result of fibrinolysis was assessed by transthoracic echo-Doppler exam in 2 cases, by TEE in 2, and by both in 1 patient. Transient ischemic attack occurred in one case as the complication of treatment.

In Conclusion: the fibrinolytic treatment of mitral prosthetic valve thrombosis based on TEE findings is an effective and safe therapeutic modality.