Fibrinolysis of mechanical prosthetic valve XXXX : a single-center study of 127 cases.

@entity1 @entity548 @entity887 @entity854 @entity715 @entity204
OBJECTIVES: This study was designed to analyze the results of fibrinolytic treatment (FT) in a large single-center group of @entity1 with @entity715 ( @entity715 ). BACKGROUND: Fibrinolytic treatment of @entity715 represents an alternative to surgery, but is still controversial because of the risk of @entity887 . METHODS: A total of 110 consecutive @entity1 presenting with 127 instances of @entity715 received FT between 1978 and 2001. The diagnosis of @entity715 was established mainly by fluoroscopy and/or echocardiography. The first fibrinolytic agent used was streptokinase (SK) in 49 cases, urokinase (UK) in 41 cases, and recombinant tissue-type plasminogen activator (rtPA) in 37 cases. A second FT was consecutively infused in 38 @entity1 (30%) and a third FT in 11 others. The efficacy of FT was assessed from hemodynamic parameters derived from echographic examinations as well as on clinical grounds. RESULTS: Complete resolution of @entity854 was seen in 90/127 @entity1 , partial resolution in 22/127 @entity1 , and no change in 15/127 @entity1 after one or more consecutive fibrinolytic regimens. When SK or rtPA were used as the first fibrinolytic agent, they appeared significantly superior to UK in terms of valve reopening. Fifteen @entity1 died. @entity548 were observed in six @entity1 . Nineteen documented embolic events occurred during FT. Finally, @entity715 recurred in 24 @entity1 , 17 of whom were retreated with lytic agents. CONCLUSIONS: These results indicate that FT is effective in most cases of @entity715 , regardless of prosthesis or site involved. However, @entity887 , @entity548 , and @entity204 were not uncommon after lytic therapy of left-sided @entity715 , limiting its application to @entity1 at high risk with alternative treatment.
