Rinaldi J P, Yassine M, Aboujaoudé F, Belhakem H, Alsagheer S, Ben Ahmed F, Lemarié P, Boursier M, Khalifé K
Service de cardiologie, hôpital Bon-Secours, Metz.
Arch Mal Coeur Vaiss. 1999 Apr;92(4):427-30.
The authors report the case of a 28 year old woman admitted as an emergency at 15 weeks' amenorrhea for malaise with transient aphasia and orthopnoea due to massive thrombosis of a St Jude aortic valve prosthesis implanted two years previously. This complication occurred after relay of oral anticoagulants with subcutaneous heparin therapy. After a medico-surgical and obstetrical discussion, the indication for thrombolytic therapy with 50 mg of rt-PA over two hours was decided with an excellent clinical and echocardiographic, immediate and lasting result, without any maternal or foetal complication. This enabled pregnancy to be continued to term under oral anti-coagulant therapy. Caesarean section was performed at 8 months leading to the birth of a healthy child. Echocardiographic and radioscopic parameters in the post-partum period showed good prosthetic valve function with no indication for reoperation. This case is original by the absence of neurological and obstetrical complications of thrombolysis, the continuation of pregnancy to term and complete lysis of the thrombus without replacement of the valvular prosthesis.
作者报告了一例28岁女性病例，该女性在停经15周时因不适、短暂性失语和端坐呼吸而急诊入院，病因是两年前植入的圣犹达主动脉瓣人工瓣膜发生大量血栓形成。这种并发症发生在口服抗凝剂换用皮下肝素治疗之后。经过内科、外科和产科会诊后，决定在两小时内使用50毫克重组组织型纤溶酶原激活剂（rt-PA）进行溶栓治疗，取得了极佳的临床和超声心动图效果，即时且持久，未出现任何母体或胎儿并发症。这使得患者能够在口服抗凝治疗下继续妊娠至足月。孕8个月时进行了剖宫产，产下一名健康婴儿。产后的超声心动图和放射学参数显示人工瓣膜功能良好，无需再次手术。该病例的独特之处在于溶栓治疗未出现神经和产科并发症，妊娠得以持续至足月，血栓完全溶解且未更换瓣膜假体。
