A Case of Prosthetic Mitral Valve Thrombosis Successfully Treated With Alteplase

A 49 years old female patient was presented with progressive pulmonary oedema in emergency room. She had mechanical aortic and mitral valve replacement in 2010. Bed-side transthoracic echocardiography was performed to the patient. An obstructive prosthetic valve thrombosis was demonstrated with apical 4 chamber imaging. Surgery was not immediately available and the patient could not be transferred because of hemodynamic instability. Fibrin-specific fibrinolytic therapy (r-tPA) with intravenosus heparine infusion was given to the patient. The mean gradient of mitral prosthetic valve with continuous wave (CW) Doppler imaging decreased from 15.7 mmHg to 6.9 mmHg after fibrinolytic therapy. Pulmonary odema relieved and neither embolic nor heamorrhagic complications were seen after fibrinolytic therapy.