Serial Fluoroscopy Guided Fibrinolytic Therapy in a Patient with Obstructive Mechanical Aortic Valve Thrombosis

Abstract

Prosthetic valve thrombosis is a life-threatening complication, which is most commonly seen in patients with poor anticoagulation. Although two-dimensional and real-time three-dimensional transesophageal echocardiography are the gold standard imaging modalities for the diagnosis of prosthetic valve thrombosis, prosthetic valves in aortic position may not be evaluated precisely. This is a serious problem during the follow-up of the patients who receive thrombolytic therapy for aortic valve thrombosis. Fluoroscopy is an alternative noninvasive imaging method, which provides valuable information about leaflet motion and may be used for such cases with restricted leaflets. Here, we report a case of aortic valve thrombosis that was managed with low-dose (25 mg) and ultra-slow (25 hours) infusion of tissue-type plasminogen activator under the guidance of serial fluoroscopy.