OBJECTIVE: To assess the short- and long-term results of the use of streptokinase (SK) for the treatment of thromboses in cardiac valvular prostheses. METHODS: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour. Short- and long-term results were assessed by radioscopy and echocardiography. RESULTS: Of the 17 patients, 12 had mechanical double-disk prostheses (4 aortic, 6 mitral, 2 tricuspid), 4 had single-disk prostheses (2 aortic, 1 mitral, and 1 tricuspid), and 1 had a tricuspid bioprosthesis. The success rate was 64.8%, the partial success rate was 17.6%, and the nonsuccess rate was 17.6%. All patients with a double-disk prosthesis responded, completely or partially, to the treatment. None of the patients with a single-disk prosthesis had complete resolution of the thrombosis. The time of streptokinase infusion ranged from 6 to 80 hours (mean of 56 h). The mortality rate due to the use of streptokinase was 5.8% and was secondary to cerebral bleeding. During streptokinase infusion, 3 (17.6%) embolic episodes occurred as follows: 1 cerebral, 1 peripheral, and 1 coronary. The rethrombosis index was 33% in a mean follow-up of 42 months. CONCLUSION: The use of fibrinolytic agents was effective and relatively safe in patients with primary thrombosis of a double-disk prosthesis. A fatal hemorrhagic complication occurred in 1 (5.8%) patient, and embolic complications occurred in 3 (17.6%) patients. In a mean 42-month follow-up, 67% of the patients were free from rethrombosis.

No Instituto Dante Pazzanese de Cardiologia, as valvoplastias percutâneas para as valvas mitral e aórtica tiveram início em agosto de 1987. Foram realizados 37 procedimentos, sendo 26 para a mitral (VMP) e 1 para a aórtica (VAP). Nas 26 VMP, obteve-se sucesso 14 vezes, tendo 4 complicações. Em 3 pacientes, o sucesso não foi total, sendo que uma paciente com insuficiência mitral recusou cirurgia, outro foi operado e o terceiro está assintomático, mas não houve melhora da área valvar e das pressões, e deve ser reestudado para posterior avaliação. Os 9 pacientes restantes foram operados, sendo realizadas 6 comissurotomias e papilarotomias e 3 substituições valvares. A indicação cirúrgica se deu por tamponamento cardíaco em 1 caso, rotura de músculo papilar com conseqüente insuficiência em outro, 1 caso de baixo débito, punção da aorta em 4 casos e não passagem do cateter para o átrio esquerdo em 2 com suspeita de tamponamento não confirmada. O paciente submetido a VAP obteve melhora imediata do gradiente, mas faleceu 1 mês após, em insuficiência cardíaca. As valvoplastias percutâneas têm apresentado uma alternativa no tratamento das lesões valvares e são uma opção, principalmente para casos de valvas não calcificadas e com o aparelho subvalvar não comprometido. Devem ser lembradas nos casos em que a cirurgia é de alto risco, como em idosos, pneumopatas e nefropatas.

Since August 1987, at the Instituto Dante Pazzanese de Cardiologia (IDPC) percutaneous mitral and aortic valvuloplasty was performed in 27 patients. In 26 for mitral and in 1 for aortic valve disease. In 26 patients mitral valvuloplasties success was accomplished in 14 patients. From those we had some complications in 4. The success was not total in 3 patients. One patient with mitral insufficiency refused surgery; the second one underwent surgery, and the third one is assymptomatic but without increase in valve area or drop in the gradient and will be reviewed. The last 9 patients underwent surgery. Six underwent commissurotomy and papilotomy and 3, valve replacement. The surgical indications were: cardiac tamponade in one, papilary muscle rupture in another one, low cardie output in 1 and puncture of the aorta in 4 cases. The catheter did not reach the left atrium in the last 2 cases and the hypothesis of cardiac tamponade was suspected, but not confirmed. The patient who underwent aortic valvuloplasty had the gradient dropped, but died one month later, in heart failure. Percutaneous valvuloplasty is an alternative treatment for patients with mitral or aortic valve stenosis without calcification or alterations of the subvalvar apparatus, mainly in those cases in which the surgery is of high risk like the elderly, in patient with renal and chronic lung diseases.