Successful fibrinolytic treatment for recurrent thrombosis on aortic valve prosthesis.

A 15-year-old girl with a prosthetic aortic valve had recurrent episodes of prosthetic valve thrombosis. She had had an emergency operation that included aortic valve replacement because of congestive heart failure secondary to aortic regurgitation due to annuloaortic ectasia complicated by aortitis syndrome. She had been on warfarin. On each admission, fibrinolytic therapy was given to her because she refused reoperation. The therapy was successful and without any complications. After the Thrombotest index was controlled between 6% and 15%, prosthetic valve thrombosis did not recur. The values of beta-thromboglobulin and platelet factor 4 were also kept within the normal range. We concluded that: (1) in circumstances that prevented surgery, fibrinolytic therapy was successful. (2) Adequate anticoagulant therapy prevented recurrence of prosthetic valve thrombosis. (3) Elevations of beta-thromboglobulin and platelet factor 4 proved to be diagnostic indicators for prosthetic valve thrombosis.