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ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 74-79

Clinical profile of prosthetic heart valve thrombosis and outcome analysis of fibrinolytic therapy versus surgical management: A single-center experience


1 Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat, India
2 Department of Research, U. N. Mehta Institute of Cardiology and Research Centre, B. J. Medical College, Ahmedabad, Gujarat, India

Correspondence Address:
Vishal Sharma
Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/heartindia.heartindia_5_20

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Context: The main aim of the study is to find out efficacy, outcomes, and complications of thrombolytic therapy and surgery for obstructive prosthetic heart valve thrombosis (PHVT). Materials and Methods: This was a prospective, observational study done on 130 patients with PHVT, from January 2016 to December 2017. Baseline details, clinical investigations, echocardiography, and fluoroscopy were done. In fibrinolytic therapy, group agents used were streptokinase and urokinase. Out of 130, 115 patients were followed for up to 6 months after the discharge. Results: Majority of the patients were females (66.9%). Sixty-five (50%) patients were in the New York Heart Association Class III, whereas 55 (42.3%) and 10 (7.7%) patients were in Class IV and II, respectively. Nearly 34.6% patients had AF, and remaining 63.1% had sinus rhythm. Out of 130 patients, 26 (20%) patients had single-leaflet valve and 103 (79.2%) patients had bileaflet valve, and only one patient had ball and cage type of the valve. Out of 130 patients, 81 (62.3%) patients received fibrinolytic therapy as the first-line therapy and 49 (37.7%) patients underwent surgery initially. In fibrinolytic therapy group, three patients underwent surgery due to failed fibrinolytic therapy. Fifty-three patients (65.5%) had complete hemodynamic and clinical success without any complications; 28 patients (34.5%) had failure. Of 130 patients, 49 patients underwent surgery as the initial treatment. In the surgical group, three patients died out of 52 patients; mortality rate was 5.80%. Conclusion: Surgery should be offered to patients with contraindications for fibrinolytic therapy as in case of recurrent PHVT surgery offers better outcome with lesser recurrences when compared with fibrinolytic therapy.


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