Thrombolytic Rx with rt-PA for mechanical valve thrombosis i
The present case has been published in the Journal of Cardiology Cases.

Learning Points:-
• The coagulation status is activated and the fibrinolytic activity is reduced during pregnancy.

• Prosthetic valve thrombosis during pregnancy is known as a life-threatening event for mother and fetus.

• The treatment strategy for this complication is not well established. Low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) therapy showed acceptable results.

• This case report shows that rt-PA therapy for the prosthetic valve thrombosis in a Japanese pregnancy woman could be an alternative treatment strategy to surgery.

A 29-year-old woman was admitted due to the diagnosis of pregnancy at 5 weeks and a day. She underwent valve replacement with mechanical heart valve (MHV: SJM valve) for congenital mitral valve regurgitation, when 11 years old. Warfarin 4 mg was used for anticoagulation. After admission, warfarin was replaced by unfractionated heparin (UFH). She developed exertional dyspnea at 8 weeks of pregnancy.

Echocardiogram and fluoroscopy showed an immobile leaflet in the closed position. She was diagnosed with mechanical valve thrombosis. Cardiac surgery or thrombolytic therapy (TT) were treatment options. TT is not established, but is reported to be safer than cardiac surgery.

Recently, low-dose, slow infusion of recombinant tissue plasminogen activator (rt-PA) therapy showed acceptable results. About 2.5 h after an intravenous injection of rt-PA, diastolic rumble improved to the normal range of leaflet. Thereafter, warfarin was restarted and there was no recurrence of symptoms and no abortion.

She was readmitted for the scheduled Caesarean section (CS) at 32 weeks of pregnancy, and warfarin was replaced with UFH. At 34 weeks of pregnancy, a baby was delivered by CS. She suffered hemostasis after surgery under the anticoagulation. Postoperative day 31, both mother and a child were healthy and left the hospital.

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