Renal artery embolism following thombolytic therapy for prosthetic valve thrombosis
Nagaraja Moorthy1, Sudeep Kumar1, Aditya Kapoor1, Sunil Kumar2 1 Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Date of Web Publication
13-Oct-2011
Correspondence Address: Sudeep Kumar Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226 014 India
Source of Support: None, Conflict of Interest: None
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DOI: 10.4103/1995-705X.86021
How to cite this article: Moorthy N, Kumar S, Kapoor A, Kumar S. Renal artery embolism following thombolytic therapy for prosthetic valve thrombosis. Heart Views 2011;12:81
How to cite this URL: Moorthy N, Kumar S, Kapoor A, Kumar S. Renal artery embolism following thombolytic therapy for prosthetic valve thrombosis. Heart Views [serial online] 2011 [cited 2023 Nov 29];12:81. Available from: https://www.heartviews.org/text.asp?2011/12/2/81/86021
A 34-year-old male was referred to our emergency department with history of acute onset rapidly progressive dyspnoea of 24 hour duration. He gave history of chronic rheumatic heart disease for which he underwent both aortic and mitral valve replacement 4 years before presentation. On clinical examination he was in frank pulmonary edema. Mitral prosthetic valve click was not audible and there was a mid diastolic rumble at apex. The clinical diagnosis of possible mitral prosthetic valve thrombosis was confirmed on Doppler echocardiography. Transthoracic echocardiography showed restricted mitral prosthetic valve motion [Video 1] with fuzzy echogenic structure on prosthetic mitral valve. The mitral inflow gradient was 54/42mmHg. He was thrombolysed with IV streprokinase bolus followed by infusion for 24 hours. Later IV conventional heparin was started. There was dramatic improvement in pulmonary edema and mitral inflow gradient decreased to 16/11 mmHg.
Twenty-four hours after streptokinase infusion, he complained of severe abdominal pain. CECT abdomen showed a wedge shaped noncontrast enhancement of middle 2/3 rd of the right kidney [Figure 1]a suggestive of renal infarction. Volume rendered CT image showed total occlusion of upper division of the right renal artery with barely visible renal tissue [Figure 1]b. He was successfully managed conservatively with IV heparin followed by oral anticoagulant to maintain INR at therapeutic range.
Figure 1: a: Contrast enhancing CT aortography showing noncontrast enhancing wedge shaped lesion in right kidney suggestive of right renal infarction (arrow in panel A) Figure 1: b: Volume rendered CT image showing total cut off of right upper division of right renal artery (arrow in panel B) with barely visible right renal tissue
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