49 yaşında kadın hasta, progresif pulmoner ödem tablosu ile acile getirildi. 2010 tarihinde mekanik aort kapak replasmanı (AVR) ve mitral kapak replasmanı (MVR) hikayesi olan hastaya yatak başı transtorasik ekokardiyografi yapıldı. Apikal 4 boşluk görüntüleme ile mitral konumda tıkayıcı protez kapak trombozu saptandı. Acil cerrahi uygulanamayan ve hemodinamik instabilite sebebiyle transfer edilemeyen hastaya, intravenöz heparin infüzyonu eşliğinde, fibrin spesifik fibrinolitik tedavi (r-tPA) uygulandı. Fibrinolitik tedavi öncesi mitral protez kapakta sürekli dalga (CW) doppler görüntüleme ile ölçülen 15.7 mmHg ortalama gradient, fibrinolitik tedavi sonrası 6.9 mmHg’ye geriledi. Pulmoner ödem tablosu düzelen hastada fibrinolitik tedavi sonrası embolik veya hemorajik komplikasyon gözlenmedi

A 49 years old female patient was presented with progressive pulmonary oedema in emergency room. She had mechanical aortic and mitral echocardiography was performed to the patient. An obstructive prosthetic valve thrombosis was demonstrated with apical 4 chamber imaging. Surgery was not immediately available and the patient could not be transferred because of hemodynamic instability. Fibrin-specific fibrinolytic therapy (r-tPA) with intravenosus heparine infusion was given to the patient. The mean gradient of mitral prosthetic valve with continuous wave (CW) Doppler imaging decreased from 15.7 mmHg to 6.9 mmHg after fibrinolytic therapy. Pulmonary odema relieved and neither embolic nor heamorrhagic complications were seen after fibrinolytic therapy