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Appropriate guidelines are not available at present for the management of patient with acute prosthetic heart valve thrombosis presenting with New York Heart Association Class IV symptoms and having deranged coagulation profile. Here, we thrombolyzed one such patient with tissue plasminogen activator (alteplase) using very slow infusion (25 mg over 24 h) which resulted in rapid improvement in symptoms and subsequent resolution of pulmonary edema with simultaneous improvement of echocardiographic gradient and fluoroscopic movement of leaflets.