Successful thrombolysis of mitral valve prosthesis by streptokinase during pregnancy.

A 37 year old female patient presented with the clinical picture of pulmonary edema while pregnant (13 weeks). Eight years earlier she underwent mitral valve replacement because of rheumatic mitral incompetence using bileaflet StJude prosthesis. Her oral anticoagulation maintenance therapy (Coumadin) was discontinued by her physician and shifted to subcutaneous unfractionated heparin 10 days prior to her presentation. Immediate 2D-echodoppler and cinefluoroscopy showed evidence of mitral prosthesis malfunction and stuck prosthetic valve leaflets. Successful restoration of proper prosthesis function was achieved by prolonged intravenous thrombolytic therapy (Streptokinase).