Yusuf M M, Archbold R A, Wood A, Dymond D
Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK.
Heart. 2004 Apr;90(4):e18. doi: 10.1136/hrt.2003.019802.
Prosthetic valve thrombosis (PVT) is classically a cardiothoracic surgical emergency. Case series, however, report thrombolysis as first line management for PVT. A case of mitral PVT treated successfully with thrombolysis is described. Immediately after thrombolysis a trivial paraprosthetic leak noted on pretreatment transoesophageal echocardiography had increased significantly in severity. The paraprosthetic leak subsequently required repeat mitral valve replacement. It is speculated that the thrombolytic treatment interfered with the usual healing process by disrupting the fibrin deposited at the valve ring margin. This suggests that fibrin is important in the formation of the annular seal of the prosthetic valve and that patients receiving thrombolysis should be monitored for this complication.
人工瓣膜血栓形成（PVT）传统上是心胸外科的急症。然而，病例系列报道称溶栓是PVT的一线治疗方法。本文描述了一例通过溶栓成功治疗的二尖瓣PVT病例。溶栓后立即发现，治疗前经食管超声心动图检查发现的轻微人工瓣膜旁漏在严重程度上显著增加。随后该人工瓣膜旁漏需要再次进行二尖瓣置换。据推测，溶栓治疗通过破坏沉积在瓣膜环边缘的纤维蛋白干扰了正常的愈合过程。这表明纤维蛋白在人工瓣膜环周密封的形成中很重要，接受溶栓治疗的患者应监测这种并发症。
