Barrios-Martínez DD, Pinzon YV, Giraldo V, Gonzalez G. Thrombolysis in dysfunctional valve and stroke. World J Crit Care Med 2025; 14(2): 96624 [DOI: 10.5492/wjccm.v14.i2.96624]
Corresponding Author of This Article
Dormar David Barrios-Martínez, MD, Professor, Department of Critical Care, Hospital Universitario San Vicente Fundación, Calle 64 # 51 D-154, Medellin 050010, Antioquia, Colombia. dormar.barrios@sanvicentefundacion.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 9, 2025; 14(2): 96624 Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.96624
Thrombolysis in dysfunctional valve and stroke
Dormar David Barrios-Martínez, Yuri Valentina Pinzon, Veronica Giraldo, Gina Gonzalez
Dormar David Barrios-Martínez, Department of Critical Care, Hospital Universitario San Vicente Fundación, Medellin 050010, Antioquia, Colombia
Dormar David Barrios-Martínez, Department of Critical Care, Hospital General de Medellín, Medellin 050015, Antioquia, Colombia
Dormar David Barrios-Martínez, Department of Critical Care, CES University, Medellin 050010, Antioquia, Colombia
Yuri Valentina Pinzon, Department of Critical Care, Somer Clinic, Rionegro 054040, Antioquia, Colombia
Veronica Giraldo, Department of Critical Care, Hospital Universitario Mayor-Mederi, Bogota 110311, Colombia
Gina Gonzalez, Department of Cardiology, Hospital Universitario Fundación Santa Fe, Bogota 505000, Colombia
Co-first authors: Dormar David Barrios-Martínez and Yuri Valentina Pinzon.
Author contributions: Barrios-Martínez DD, Giraldo V, and Pinzon YV contributed to the conceptualization of this case report; Barrios-Martínez DD and Pinzon YV were involved in the writing and preparation of the original draft; Gonzalez G and Carreño JN contributed to the reviewing and editing of the manuscript. All authors have read and approved the final manuscript, Professor Carreño JN passed away, when all finish the manuscript. Barrios-Martínez DD and Pinzon YV contributed equally to this work as co-first authors.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dormar David Barrios-Martínez, MD, Professor, Department of Critical Care, Hospital Universitario San Vicente Fundación, Calle 64 # 51 D-154, Medellin 050010, Antioquia, Colombia. dormar.barrios@sanvicentefundacion.com
Received: May 11, 2024 Revised: January 11, 2025 Accepted: February 18, 2025 Published online: June 9, 2025 Processing time: 292 Days and 0.5 Hours
Abstract
BACKGROUND
Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality. The prevalence of at least moderate valvular heart disease is 2.5% across all age groups, but its prevalence increases with age. Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context, respectively. Surgical valve replacement (or mitral valve repair) is the standard of care for treating heart valve disease. However, the replacement of a prosthetic heart valve can lead to complications, either in the peri-procedural phase or in the long-term follow-up period.
CASE SUMMARY
We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy. She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology. A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs. Furthermore, a possible microthrombotic lesion was suspected. Therefore, systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.
CONCLUSION
This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.
Core Tip: We describe the case of a 71-year-old woman with a history of mitral valve replacement who presented with cardioembolic stroke due to prosthetic valve dysfunction and thrombotic obstruction. Advanced imaging confirmed the diagnosis. After careful assessment by neurology, cardiology, and critical care teams, systemic thrombolysis was performed as an alternative to surgery. The intervention successfully restored valve function without complications. This case demonstrates the value of collaborative decision-making and tailored treatment strategies in optimizing outcomes for patients with prosthetic valve thrombosis and associated complications.
