Abstract

Acute heart failure is an important presentation in the Acute Medical Unit. We describe a case of successful repeat thrombolysis in an elderly woman presenting as an emergency with severe pulmonary oedema, due to acute prosthetic mitral valve thrombosis. The diagnostic imaging and therapeutic modalities available are also described.This case highlights the need for acute physicians to consider prosthetic valve thrombosis in the differential for patients with metallic heart valves who present with acute heart failure or cardiogenic shock.
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References

1. Edmunds LH, Jr. Thromboembolic complications of current cardiac valvular prostheses. Ann Thorac Surg 1982; 34: 96–106.
2. Kontos GJ, Jr., Schaff HV, Orszulak TA, et al. Thrombotic obstruction of disc valves: clinical recognition and surgical management. Ann Thorac Surg
   1989; 48: 60–5.
3. Vongpatanasin W, Hillis D, Lange RA. Prosthetic heart valves. N Engl J Med 1996; 335: 407–416.
4. Chesebro JH, Fuster V, Optimal Antithrombotic Therapy for Mechanical Prosthetic Heart Valves. Circulation 1996; 94: 2055–2056.
5. Stein PD, Alpert JS, Copeland J, et al. Antithrombotic therapy in patients with mechanical and biologic prosthetic heart valves. Chest. 1995;108(suppl):371S–379S.
6. Chesebro JH, Adams PC, Fuster V. Antithrombotic therapy in patients with valvular heart disease and prosthetic heart valves. J Am Coll Cardiol.1986; 8: 41B–56B.
7. Heras M, Chesebro JH, Fuster V, et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995; 25: 1111–1119.
8. Roudaut R, Labbe T, Lorient-Roudaut MF, et al. Mechanical cardiac valve thrombosis: is fibrinolysis justified? Circulation 1992; 86(5 Suppl): 118–119.
9. Barbetseas J, Nagueh SF, Pitsavos C, et al. Differentiating thrombus from pannus formation in obstructed mechanical prosthetic valves: an evaluation of clinical, transthoracic and transesophageal echocardiographic parameters. J Am Coll Cardiol 1998; 32: 1410–1417.
10. Q. Macmanus, M. T. Metzdorff, G. L. Grunkemeier and A. Starr. Thrombotic and embolic complications with silastic ball prosthetic valves. European Heart Journal 1984 5(Supplement D):59-63; doi:10.1093/eurheartj/5.suppl_D.59.
11. AU Remadi JP; Baron O; Roussel C; Bizouarn P; et al. Isolated mitral valve replacement with St. Jude medical prosthesis: long-term results: a follow-up of 19 years. Circulation 2001 Mar 20; 103(11): 1542–5.
12. Bayliss A, Faber P, Dunning J, Ronald A., What is the optimal level of anticoagulation in adult patients receiving warfarin following implantation of a mechanical prosthetic mitral valve? Interact Cardiovasc Thorac Surg. 2007 Jun; 6(3): 3906. Epub 2007 Feb 9.
13. Lengyel M, Fuster V, Keltai M, et al. Guidelines for management of leftsided prosthetic valve thrombosis: a role for thrombolytic therapy. Consensus Conference on Prosthetic Valve Thrombosis. J Am Coll Cardiol. 1997; 30(6): 1521–6.
14. Bonow RO, Carabello B, de Leon AC, et al. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Heart Valve Dis. 1998; 7(6): 672–707.
15. Ozkan M, Kaymaz C, Kirma C, et al. Intravenous thrombolytic treatment of mechanical prosthetic valve thrombosis: a study using serial transesophageal echocardiography. J Am Coll Cardiol. 2000; 35(7): 1881–9.
16. Shapira Y, Vaturi M, Hasdai D, Battler A, Sagie A.The safety and efficacy of repeated courses of tissue-type plasminogen activator in patients with stuck mitral valves who did not fully respond to the initial thrombolytic course. J Thromb Haemost. 2003; 1(4): 725–8.
17. Lengyel M, Horstkotte D, Völler H, Mistiaen WP; Working Group Infection, Thrombosis, Embolism and Bleeding of the Society for Heart Valve Disease. Recommendations for the management of prosthetic valve thrombosis. J Heart Valve Dis. 2005 Sep; 14(5): 567–75; 2008 9(4): 413–414.