Squara P, Dubois C, Laurenceau J L, Prasquier R, Diebold H, Hanania G, Mesnildrey P
CERIC, centre chirurgical Ambroise-Paré, Neuilly.
Arch Mal Coeur Vaiss. 1992 Jul;85(7):1035-7.
The authors report a case of thrombolytic therapy with streptokinase in the early postoperative period after aortic valve replacement with a Saint Jude medical prosthesis. After good initial progress, the patient had to be reoperated on the 12th postoperative day for sternal disunion. Reoperation was followed rapidly by progressive thrombosis of the aortic prosthesis demonstrated by repeated Doppler echocardiographic examination. The impossibility of eliminating mediastinitis led to medical thrombolysis. The outcome was favourable after a regressive cerebral embolic event. This case illustrates the value of Doppler echocardiographic examination in the postoperative period. Thrombolysis may constitute an alternative to reoperation when the operative risk is high. The risk of thrombolysis may not be as great as some believe.
作者报告了1例在使用圣犹达医疗公司人工瓣膜进行主动脉瓣置换术后早期采用链激酶溶栓治疗的病例。术后初期情况良好，但患者在术后第12天因胸骨愈合不良而不得不再次手术。再次手术后，经反复多普勒超声心动图检查证实，人工主动脉瓣迅速出现进行性血栓形成。由于无法消除纵隔炎，于是进行了药物溶栓治疗。在发生1次退行性脑栓塞事件后，结果良好。该病例说明了多普勒超声心动图检查在术后的价值。当手术风险较高时，溶栓可能是再次手术的一种替代方法。溶栓的风险可能并不像一些人认为的那么大。
