[Early postoperative (10th day) thrombosis of a Starr mitral prosthesis. Successful fibrinolytic treatment].

The authors report a case of early postoperative thrombosis of a Starr-Edwards mitral valve prosthesis in a 36 year old female who had undergone closed heart surgery nine years previously for tight mitral stenosis. Severe restenosis led to mitral valve replacement in 1980, and the insertion of a Starr-Edwards prosthesis. On the 8th postoperative day thrombosis of the prosthesis presented with pulmonary oedema and a change in the prosthetic valve sounds which regressed with therapy. The diagnosis was confirmed on the 9th postoperative day by left heart catheterisation and angiography. Fibrinolytic treatment was instituted on the 10th postoperative day with 4500 u/Kg of Urokinase for 24 hours. Pulmonary oedema regressed at the 6th hour of treatment and the prosthetic valve sounds reverted to normal. No significant complication was observed. The good result has been maintained up to the 6th postoperative month. This case demonstrates the possibility of using fibrinolytic therapy in the early postoperative period after valve replacement: this should be weighed in the balance against the mortality of reoperation in such cases of early thrombosis of prosthetic heart valves.