Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixteen cases of prosthetic valve thrombosis (9 mitral, 5 aortic), occurring in 14 patients, were treated by fibrinolysis. All were disc prostheses. The clinical state of the patients was very poor in 11 of the 16 cases with pulmonary oedema, low output and arrhythmias, but less dramatic in the 5 others who presented with thromboembolism and left ventricular failure. The diagnosis was made by echocardiography (9 cases), radio-cinema of the valve (9 cases) and/or angiography (4 cases). The therapy comprised Urokinase (UK) 4,500 U/kg/hour (6 cases) of Streptokinase (SK) 2,000,000 U in 10 hours (7 cases) or SK and UK at equal doses (3 cases). The outcome was assessed clinically, echocardiographically and radiologically. There were 11 definite successes, 2 partial improvements requiring surgical revision, 2 apparent successes but with massive recurrence at the 7th and 10th days, and 1 failure. Although the biological activity of SK is greater than that of UK, the clinical results were comparable with both fibrinolytic agents. Four patients had regressive embolic episodes during lysis of the valvular thrombosis. As fibrinolytic therapy was effective in 70 p. 100 of patients in this series, it could provide an acceptable alternative to surgery, especially in patients who would be poor operative risks. The management of patients after successful fibrinolysis remains divided between intensive medical follow-up or prosthetic valve replacement.
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PMID:[Fibrinolytic treatment of valve thrombosis. Apropos of 16 cases]. 640 21

The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase.
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PMID:[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature]. 643 46

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.
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PMID:[Early postoperative (10th day) thrombosis of a Starr mitral prosthesis. Successful fibrinolytic treatment]. 680 52