ArticleJACC. Case reports2026
Fibrinolysis for Apical Thrombus as a Bridge to Emergent Valve-in-Valve Transcatheter Aortic Valve Replacement.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundLeft ventricular (LV) thrombus is traditionally a contraindication to transcatheter aortic valve replacement due to embolic risk. Consequently, management of valvular cardiogenic shock complicated by LV thrombus identifies unique challenges that require innovative strategies. CASE SUMMARY: A 58-year-old woman with critical bioprosthetic aortic stenosis, cardiogenic shock, and large LV thrombus (2.8 × 2.6 cm) underwent successful valve-in-valve transcatheter aortic valve replacement after systemic fibrinolysis bridge therapy. WHY BEYOND THE GUIDELINES: Current guidelines contraindicate transcatheter aortic valve replacement in patients with LV thrombus. This case demonstrates the novel use of low-dose, slow infusion tissue plasminogen activator as a bridge therapy to enable life-saving intervention. DISCUSSION: Pulsed delivery of small doses of systemic fibrinolytic with hemodynamic and echocardiographic monitoring may be suitable as a bridge to definitive management in valvular shock patients with LV thrombus. Minimizing instrumentation during structural heart procedures complicated by LV thrombus is critical. TAKE-HOME MESSAGES: Low-dose, slow-infusion fibrinolysis coupled with echocardiographic monitoring may serve as bridge therapy to urgent structural cardiology intervention in carefully selected patients with LV thrombus and cardiogenic shock.
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