Study of clinical profile and outcomes of fibrinolysis in Prosthetic valve thrombosis

Background: There is a high prevalence of rheumatic heart disease in young in India and the majorities undergo valve replacement surgery at a young age compared to developed countries. Prosthetic Valve thrombosis (PVT) is a pathological entity characterized by thrombus formation on the prosthetic structures, with subsequent PV dysfunction with or without thromboembolism (TE). Obstruction to prosthetic heart valve could be due to thrombus, pannus formation, vegetation, or patient prosthesis mismatch. The treatment options for PVT include fibrinolysis, anticoagulation and surgery. Due to the lack of larger prospective studies and randomized trials, the choice of treatment for PVT remains controversial. This study aims to evaluate the clinical presentation, diagnostic features, treatment strategies, complications of prosthetic heart valve thrombosis (PHVT) and to determine efficacy, outcomes and complications of thrombolytic therapy during hospital stay. Methodology: This study is an observational and prospective study conducted between January 2021 to June 2022 for period of 18 months at king George Hospital, which included 115 in patients with prosthetic valve thrombosis. The statistical analysis was done in MS Excel and SPSS and the descriptive analysis was carried out by standard deviation in quantitative variable, proportion and categorical variable. Results: The mean age of patients was 40+/-1.927(+/-4.82) with an age range of 20-80 years. Out of 115 patients 39.2% of patients were females and 60.8% were males48.7% of the patient’s developed thrombosis after more than one year of valve surgery and 51.3% of patients developed thrombosis before 1 year of surgery. Mitral valve thrombosis was seen in 95 patients (82.6%), aortic valve thrombosis in 11 patients (9.6%) 9 patients ( 7.8%) had double valve replacement. Thrombolysis with Streptokinase in Mitral PVT,35 patients had complete response,16 patients had partial response and 10 patients were dead/failed response. Thrombolysis with Tenecteplase in Mitral PVT,18 patients had complete response,6 patients had partial response and 3 patients were dead/failed response. Conclusion: Early clinical recognition of PVT plays an important role in the management of Prosthetic valve thrombosis, as subtle signs like increase in dyspnoea and muffling of clicks may be picked up at bedside and leads to suspicion of PVT. Thrombolytic therapy can be considered as an effective initial intervention and surgery should be recommended for valve dehiscence, large thrombus and for those patients having contraindications to thrombolysis. Regular follow-ups with anticoagulation maintenance are of prime importance in prevention of Prosthetic valve thrombosis.