Successful thrombolysis by low dose slow intravenous alteplase infusion in critically ill patients with stuck prosthetic mitral valve: a case study

Prosthetic valve thrombosis(PVT) contributes to significant post valve replacement mortality and morbidity.Treatment guidelines are controversial,ranging from surgical intervention to thrombolysis. We report a case study of two challenging patients who presented in our hospital,known Rheumatic Heart Disease,Post Mitral Valve Replacement,with Acute Left ventricular failure in NYHA class IV and PVT,of which one had coagulopathy with grossly deranged INR.Both patients were put on intermittent non invasive ventilator and inotropic supports,and successfully thrombolysed with low dose slow intravenous Alteplase infusion given every 6 hours in discrete doses with monitoring of PT/INR and mitral valve gradients,resulting in remarkable clinical improvement .Their successful treatment shows that thrombolysis can be considered as an effective treatment modality in high risk surgery patients with stuck prosthetic mitral valve.

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