الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Prosthetic valve thrombosis has been defined as any obstruction of a prosthesis by non-infective thrombotic material. Despite innovations in prosthetic valve design and the use of specialized materials to coat valve surfaces, the reported incidence of thrombosis of prosthetic mechanical heart valves still ranges from 0.03% to 4.3% per year.
Thrombotic prosthetic valve occlusion is a devastating complication has been reported to occur in 0.5% to 8% of the left-sided mechanical prosthetic valves and up to 20% of tricuspid prostheses.
Intravenous thrombolytic treatment for thrombosed prosthetic valves has been suggested as an alternative to the traditional surgical thrombectomy and valve replacement which have both been used routinely for this condition. However, operative mortality was high with these procedures.
The objective of this study was to analyze the results in a series of patients with prosthetic heart valves in whom the thrombolytic treatment was administered in discrete and successive treatment sessions guided by serial transesophageal echocardiography (TEE). We have analyzed the success and the complications rates according to the clinical and the echocardiographic characteristics of the patients enrolled in this study. We have also determined the in-hospital morbidiy and mortality among those patients.
The study population consisted of 23 symptomatic patients over a period of one year with distinct prosthetic valve thrombosis in cardiology department of Alexandria main University Hospitals. Those patients underwent thrombolytic treatment sessions. TEE examination had been performed at baseline and was repeated after each thrombolytic treatment session.
The present study showed that intravenous thrombolysis can be done with a reasonably high success rate in prosthetic valve thrombosis by administering thrombolytics in successive episodes with acceptable clinical response rates. The relief of haemodynamic obstruction by thrombolysis can be monitored by ecchocardiography.
Intravenous thrombolysis for prosthetic valve thrombosis was shown, in the current study in addition to several others, that it can be achieved with a relatively low risk of complications, when compared to surgical modalities, and a high success rate in both obstructive and nonobstructive prosthetic valve thrombosis. Thrombolytic treatment was also shown to be effective in both mitral and aortic valve thrombi and in various types of mechanical prosthesis regardless of the treatment protocol adopted.
Additionally, thrombolytic treatment can be implemented in a wide variety of patients, regardless of symptoms duration or severity, except for hemodynamically compromised patients (such as those with cardiogenic shock or overt pulmonary edema) who are otherwise good surgical candidates who may not withstand the delay to surgery and in whom thrombolytic therapy can be largely ineffective.