Successful thrombolysis of aortic prosthetic valve thrombosis during first trimester of pregnancy

Abstract

Prosthetic heart valve thrombosis during pregnancy is life-threatening. Standard surgical treatment using cardiopulmonary bypass carries high maternal and fetal complications. Here we report a case of an antenatal female in first trimester with aortic prosthetic valve thrombosis (PVT), who was successfully thrombolysed with streptokinase with no complication to mother or fetus. The aim was to justify the usefulness of thrombolysis as a treatment option for prosthetic valve thrombosis in antenatal patients. A 35-year-old female patient presented in the first trimester of pregnancy with PVT at aortic position. After due consent, thrombolysis was undertaken with streptokinase. During the hospital course, she was followed clinically and with echocardiography. She symptomatically improved with thrombolysis. Transthoracic echocardiography showed complete resolution of thrombus. Peak trans-aortic velocity improved from 5.5 m/s to 3.7 m/s. She delivered a normal baby uneventfully in follow up at full term of pregnancy with no complications. Fibrinolytic therapy for mechanical valve thrombosis is a reasonable alternative to surgery in first trimester of pregnancy.

KEY WORDS: Prosthetic valve thrombosis; Echocardiography; Streptokinase; Thrombolysis; Fetus