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Successful Treatment of Severe Mechanical Mitral Valve Thrombosis With Tissue Plasminogen Activator in a 7-Month-Old Infant

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Abstract

Severe thrombosis of a mechanical valve is a rare complication in pediatric patients. Thrombolytic therapy as treatment of mechanical mitral valve thrombosis has rarely been reported in young infants. We report the successful treatment with recombinant tissue-type plasminogen activator of a mechanical mitral valve thrombus in a 7 month-old patient with trisomy 21, complete atrioventricular canal defect and pulmonary hypertension status post complete atrioventricular canal repair and subsequent prosthetic mitral valve replacement. He presented with respiratory decompensation and shock secondary to severe mechanical mitral valve stenosis. Serial echocardiograms showed significant resolution of the thrombus within 18 h of infusion with no major bleeding complications during the treatment course. Although a rare complication of mechanical valve placement in pediatrics, thrombosis of mechanical valves may result in severe hemodynamic and respiratory compromise. This case demonstrates that thrombolytic therapy is a feasible option for the treatment of critical thrombosis in pediatric patients after MVR.

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Author information

Correspondence to Eva W. Cheung.

Electronic supplementary material

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Movie Clip 1. Echocardiogram: Parasternal long axis view of the mitral valve with color Doppler before tPA treatment. An echogenic mass surrounds the prosthetic mitral valve, and there is limited excursion of the valve leaflets. There is a severely stenotic mitral valve inflow orifice by color Doppler. (MOV 2615 kb)

Movie Clip 2. Echocardiogram: Parasternal long axis view of the mitral valve with color Doppler after tPA. The mitral valve inflow orifice is now of normal diameter with unobstructed flow on color Doppler. (MOV 1578 kb)

Movie Clip 1. Echocardiogram: Parasternal long axis view of the mitral valve with color Doppler before tPA treatment. An echogenic mass surrounds the prosthetic mitral valve, and there is limited excursion of the valve leaflets. There is a severely stenotic mitral valve inflow orifice by color Doppler. (MOV 2615 kb)

Movie Clip 2. Echocardiogram: Parasternal long axis view of the mitral valve with color Doppler after tPA. The mitral valve inflow orifice is now of normal diameter with unobstructed flow on color Doppler. (MOV 1578 kb)

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Cheung, E.W., Aponte-Patel, L., Bacha, E.A. et al. Successful Treatment of Severe Mechanical Mitral Valve Thrombosis With Tissue Plasminogen Activator in a 7-Month-Old Infant. Pediatr Cardiol 34, 1903–1907 (2013). https://doi.org/10.1007/s00246-012-0446-x

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Keywords

  • Mechanical valve thrombosis
  • Thrombolytic therapy
  • Tissue-type plasminogen activator
  • Mitral valve replacement
  • Mitral stenosis