Use of tenecteplase for left-sided prosthetic valve thrombosis.

INTRODUCTION: Prosthetic valve thrombosis (PVT) following cardiac valve replacement in rheumatic heart disease patients is a common cause for referral to tertiary care centre. Although surgery has been described as the traditional choice of therapy, thrombolytic therapy has reported high success rates in published literature. CASE REPORT: This is a case report of ten patients with left-sided PVT receiving tenecteplase. The mean dose of tenecteplase used was 1.01 mg/kg given as IV bolus injection along with enoxaparin, heparin and acenocoumarol. The diagnosis and response was assessed based on trans-thoracic echocardiography. The reduction in peak transvalvular gradient was in the range of 46% - 81% and in mean transvalvular gradient was in the range of 50% - 84%. There was normalization of valve motion in all patients. There was no incidence of mortality, intracerebral hemorrhage, systemic bleeding or embolism. CONCLUSION: To our knowledge, this is the largest published evidence so far showing efficacy and safety of tenecteplase for PVT.

Risk factors for ischemic heart disease in Delhi. (A prospective study of 7000 cases).

BACKGROUND: A prospective study of 7000 consecutive patients with IHD was carried out for "traditional" risk factors at the National Heart Institute (NHI) of the All India Heart Foundation (AIHF) and compared with 1000 "normal" controls. A specially designed proforma was used. STUDY GROUP: There were 5334 men (76%) and 1666 women (24%). The ages ranged from 24 to 92 years; above 60 (35%), between 51-60 (23%), 41-50 (22%) and below 40 (21.7%). The risk factor profile for the whole group was positive family history 38%, sedentary lifestyle 56%, overweight & obesity 21%, hypertension 64%, smoking 43% diabetes 39%, hypercholesterolemia 21% with no obvious risk factor in 15%. Those with no obvious risk factors could have had some of the "new" ones, which were not addressed. 2 & 3 risk factors were present in the majority (5618 patients 80%) and multiple risk factors in 96%. Hypertension was dominant in all groups. WOMEN: Significant differences were more, sedentary lifestyle, little or no smoking, higher cholesterol and more with no obvious risk factors. PRECOCIOUS IHD: In the 22% below 40 years, there was a significantly higher family history and smoking with significant prevalence of smoking, hypertension and diabetes. EXECUTIVE GROUP: The ages ranged from 24 to 59 with none above 60. There was no obvious risk factor in 55%. Here was a positive family history in 30.8%, sedentary lifestyle in 34%, smoking in 24.7%, hypertension in 16.5%, diabetes 11.8% and high cholesterol only in 5.6%. CONCLUSION: Multiple traditional risk factors were dominant in all the groups, with hypertension heading the list. Control of these, should be the target for all preventive programmes, targeting the general population and high risk groups.