Laplace Guillaume, Lafitte Stéphane, Labèque Jean-Noèl, Perron Jean-Marie, Baudet Eugène, Deville Claude, Roques Xavier, Roudaut Raymond
Service de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Chu de Bordeaux, Pessac, France.
J Am Coll Cardiol. 2004 Apr 7;43(7):1283-90. doi: 10.1016/j.jacc.2003.09.064.
The aim of this study was to evaluate the incidence of early thrombosis, its prognostic significance, and the therapeutic implications.
Transesophageal echocardiography (TEE) is the method of choice for detecting symptomless early postoperative thrombosis of prosthetic valves. However, the clinical significance is not yet known.
Between June 1994 and December 2000, 680 consecutive patients underwent TEE on day 9 after mechanical mitral valve replacement, to search for early thrombosis. Initially, end points were the in-hospital outcome and treatment. Patients were also evaluated 34 +/- 22 months after surgery.
Sixty-four early thrombi were detected (9.4%). Two early obstructive were treated by redo-surgery. Sixty-two nonobstructive benefited from medical treatment. The patients were allocated into two groups as a function of the maximum size of thrombus: <5 mm in 29 patients (group A) and > or =5 mm in 35 (group B). During early follow-up, we observed one complicated course in group A and eight in group B. In the long-term survey, three complications were noted in group A and 11 in group B. Incidence of early (p = 0.027) and long-term (p = 0.04) complications were significantly different in the two subsets.
This study confirms the incidence of early thrombi after mechanical mitral valve replacement detected by TEE. A small (<5 mm) nonobstructive thrombus seems benign, and our experience argues in favor of medical treatment. Prognosis appears more serious for large thrombi. Medically aggressive therapy and further surgery should be considered in cases of obstructive thrombosis or large and mobile nonobstructive thrombosis.
本研究旨在评估早期血栓形成的发生率、其预后意义及治疗意义。
经食管超声心动图（TEE）是检测人工瓣膜术后无症状早期血栓形成的首选方法。然而，其临床意义尚不清楚。
在1994年6月至2000年12月期间，680例连续患者在机械二尖瓣置换术后第9天接受TEE检查，以寻找早期血栓形成。最初，终点指标是住院结局和治疗情况。患者在术后34±22个月也接受了评估。
检测到64例早期血栓（9.4%）。2例早期阻塞性血栓通过再次手术治疗。62例非阻塞性血栓通过药物治疗受益。根据血栓最大尺寸将患者分为两组：29例血栓<5 mm（A组），35例血栓≥5 mm（B组）。在早期随访期间，我们观察到A组有1例出现复杂病程，B组有8例。在长期随访中，A组有3例出现并发症，B组有11例。两组亚组的早期（p = 0.027）和长期（p = 0.04）并发症发生率有显著差异。
本研究证实了TEE检测到的机械二尖瓣置换术后早期血栓的发生率。小的（<5 mm）非阻塞性血栓似乎是良性的，我们的经验支持药物治疗。大血栓的预后似乎更严重。对于阻塞性血栓形成或大的可移动非阻塞性血栓形成，应考虑积极的药物治疗和进一步手术。
