Improvement of endothelial function early after thrombolytic therapy in patients with prosthetic heart valve thrombosis Protez kalp kapak trombozu olan hastalarda trombolitik tedavinin hemen sonrasında endotel fonksiyonlarında gözlenen iyileşme

Çakal B., Kalçık M., Güner A., Yesin M., Gürsoy M. O., Gündüz S., ...More

Turk Kardiyoloji Dernegi Arsivi, vol.48, no.6, pp.566-575, 2020 (ESCI) identifier identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 48 Issue: 6
  • Publication Date: 2020
  • Doi Number: 10.5543/tkda.2020.23621
  • Journal Name: Turk Kardiyoloji Dernegi Arsivi
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, MEDLINE, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.566-575
  • Keywords: Echocardiography, endothelial functions, flow-mediated dilatation, prosthetic valve thrombosis, transesophageal echocardiography
  • Istanbul Medipol University Affiliated: Yes


Objective: Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Thrombolytic therapy (TT) is now widely used as first-line treatment for PVT. Endothelial dysfunction has previously been reported in patients with PVT. The aim of this study was to investigate the changes in endothelial function soon after TT in PVT patients. Methods: The study group included 85 patients with PVT [female: 53 (62.3%); age: 48.7±13.9 years] who were evaluated prospectively before and shortly after TT. All of the patients were evaluated using transthoracic and transesophageal echocardiography. TT was administered in all cases with a low-dose, ultra-slow infusion regimen. Endothelial function was evaluated using a noninvasive measurement of flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia. Results: The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. The obstructive PVT patients had lower baseline FMD values than the non-obstructive PVT group (5.31±0.76% vs. 5.87±0.84%; p=0.003). TT was successful in 79 patients (92.9%). FMD was significantly increased in the successfully thrombolyzed patients after TT (5.65±0.86% vs. 7.13±1.26%; p<0.001). There was no significant difference in the FMD values after TT in patients who were unresponsive to TT (5.07±0.61% vs. 5.38±0.95%; p=0.371). There was a significant increase in FMD values after TT in patients with obstructive PVT (5.31±0.76% vs. 8.22±1.15%; p<0.001). However, this difference was not statistically significant for patients with non-obstructive PVT (5.87±0.84% vs. 6.11±0.95%; p=0.276). Conclusion: This study demonstrated that successful TT may contribute to improvement of impaired endothelial function in patients with obstructive PVT.