Percutaneous management of recurrent prosthetic valve thrombosis. Case resolution

Abstract

CASE RESOLUTION Our patient, with recurrent prosthetic valve thrombosis (PVT) and a thrombus area < 0.8 cm2 was treated with thrombolysis but without clinical or echocardiographic improvement. It was considered that a third cardiac surgery would be too risky. Since the thrombotic load was not high, we decided to proceed with the percutaneous manipulation of the valve using the technique described by Jabbour et al.1 in a patient with acute thrombosis of a tilting-disc aortic valve. This patient was treated with percutaneous manipulation of the disc trapped using a rigid catheter. Hariram2 also reported on a series of 5 patients with mitral PVT and failed fibrinolytic therapy successfully treated through percutaneous manipulation of the valve using a 6 Fr-Judkins guide catheter. In our case, the procedure was performed under general anesthesia with fluoroscopy and transesophageal echocardiography guidance. The right femoral vein was used as the access site. The transseptal puncture was performed using a Mullins introducer sheath and a Brockenbrough needle in the superior-posterior portion of the oval fossa. After the IV administration of sodium heparin (100 IU/kg) and mounted over a 0.032 in J guidewire a 3.5/6-Fr EBU guide catheter (Medtronic Launcher; Minneapolis, United States) was successfully inserted into the left...