Pediatric Cardiology and Cardiac Surgery
Vol.27 No.1 2011 (43-48)
Kazushi Yasuda,1) Shiro Ishikawa,1) Yuichi Ishikawa,1) Makoto Nakamura,1) Hiroya Ushinohama,1) Koichi Sagawa,1) Eiji Morihana,2) Naoki Fusazaki,2) Kazuhiro Hinokiyama,3) Toshihide Nakano,3) and Hideaki Kado3)
Departments of 1)Pediatric Cardiology, 2)Neonatal Cardiology, 3)Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
We report on thrombolytic therapy with a recombinant tissue plasminogen activator (rt-PA) for prosthetic valve thrombosis in a two-year-old boy with a single ventricle after an atrioventricular valve replacement (SJM Regent, 23 mm). An increase in urine volume and improvements of symptoms and signs of congestive heart failure were observed about 30 minutes after an intravenous injection of rt-PA (alteplase 40,000 I.U./kg of body weight). Fluoroscopy showed that an immobile leaflet remained fixed in the closed position before and after the therapy, while the other leaflet, which was hypomobile, improved to the normal range. Only slight nasal bleeding was observed as an adverse effect. After some improvement of congestive heart failure, he underwent atrioventricular valve replacement again, this time using an On-X mitral 23-mm valve. We conclude that thrombolytic therapy with rt-PA for the prosthetic valve thrombosis in this patient with a deteriorated hemodynamic condition was effective as a bridge therapy toward the valve re-replacement.