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OBJECTIVEWe analyzed the results of intravenous thrombolytic treatment under transesophageal echocardiographic (TEE) guidance in prosthetic valve thrombosis.BACKGROUNDThrombotic occlusion of prosthetic valves continues to be an uncommon but serious complication. Intravenous thrombolytic treatment has been proposed as an alternative to surgical intervention.METHODSIn a four-year period, 32 symptomatic patients with prosthetic valve related thrombosis underwent 54 thrombolytic treatment sessions for the treatment of 36 distinct episodes. All patients had low international normalized ratio values at the presentation. Transesophageal echocardiography was performed at baseline and repeated after each thrombolytic treatment session (total 98 TEE examinations). Streptokinase was used as the initial agent with a repeat dose given within 24 h when necessary. Recurrent thrombosis was treated either with tissue plasminogen activator or urokinase.RESULTSThe initial success after first dose was only 53% (17/32) but increased up to 88% (28/32) after repeated thrombolytic sessions upon documentation of suboptimal results on TEE examination (p < 0.01). In addition, four asymptomatic patients with large thrombi were also successfully treated with single infusion. The TEE characteristics of thrombus correlated with clinical presentation and response to lytics. Success was achieved with single lytic infusion in 40% of the obstructive thrombi as compared with 75% of the nonobstructive ones (p < 0.05). The success rates of lytic treatment were similar for mitral versus aortic valves, and for tilting disk versus bileaflet valves. Rapid (3 h) and slow (15 to 24 h) infusion of streptokinase resulted in similar success rates. However, major complications (three patients) occurred only in the rapid infusion group.CONCLUSIONIn patients with prosthetic valve thrombosis, intravenous slow infusion thrombolysis given in discrete, successive sessions guided by serial TEE and transthoracic echocardiography can be achieved with a low risk of complications and a high rate of success.

PP-354 SYNTAX (SX) score is related to increased mortality in the course of acute ST elevation myocardial infarction. SX score is expected to be higher in elderly patients. We investigated the effect of SX score which is already elevated over short and long term adverse cardiovascular events (death

PP-232 Although very high gradient levels were measured during the evaluation of ventricular septal defect (VSD) in daily practice, these measurements are generally interpreted as irrational and thus neglected. Our aim was to show that Doppler may overestimate interventricular pressure gradient in

PP-234 Bicuspid aortic valve (BAV) is the result of abnormal aortic leaflet formation during valvulogenesis. Recently, it has been shown that BAV is associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The purpose of this study was to

OP-010 PURPOSE: We aimed to investigate the predictors of microvascular obstruction (MVO) among clinical, electrocardiographic, laboratory and angiographic parameters available on admission in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary

OP-073 Although an exercise electrocardiogram test is often the first-line screening procedure for subjects with an intermediate probability of coronary artery disease (CAD), one limitation of this test is the high rate of inconclusive tests that result from borderline exercise-induced ST changes.