Vasan R S, Kaul U, Sanghvi S, Kamlakar T, Negi P C, Shrivastava S, Rajani M, Venugopal P, Wasir H S
Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
Am Heart J. 1992 Jun;123(6):1575-80. doi: 10.1016/0002-8703(92)90812-a.
Sixteen patients with echocardiographic and cinefluoroscopic evidence of Björk-Shiley prosthetic valve obstruction (13 mitral valves and 3 aortic valves) were treated with intravenous streptokinase. Streptokinase was administered as an initial bolus of 250,000 units for 30 minutes, followed by an infusion of 100,000 units/hr. Serial cinefluoroscopy and echocardiography (M-mode, two-dimensional, and Doppler) were performed at 0, 24, 48, and 72 hours of treatment. The end point of treatment was defined as near normalization of clinical, echocardiographic, and fluoroscopic parameters. Successful thrombolysis was achieved in all patients. The average duration of streptokinase therapy was 43 hours (range 2 to 72 hours). Two of 16 patients had minor systemic embolism during therapy. Short-term follow-up has shown sustained benefit in 14 of 16 patients. Two patients have had rethrombosis of the mitral prosthetic valves and have undergone thrombectomy. Our study demonstrates the feasibility, safety, and efficacy of thrombolytic therapy in the treatment of prosthetic valve thrombosis. It also emphasizes the role of serial Doppler echocardiography in guiding the duration of therapy and assessing its efficacy.
16例经超声心动图和荧光电影造影证实存在 Björk-Shiley 人工瓣膜梗阻的患者（13例二尖瓣，3例主动脉瓣）接受了静脉链激酶治疗。链激酶初始剂量为250,000单位，静脉推注30分钟，随后以100,000单位/小时的速度持续静脉滴注。在治疗0、24、48和72小时时进行了系列荧光电影造影和超声心动图检查（M型、二维和多普勒）。治疗终点定义为临床、超声心动图和荧光镜检查参数接近正常化。所有患者均成功实现溶栓。链激酶治疗的平均持续时间为43小时（范围2至72小时）。16例患者中有2例在治疗期间发生轻微全身性栓塞。短期随访显示，16例患者中有14例持续受益。2例二尖瓣人工瓣膜再次发生血栓形成，并接受了血栓切除术。我们的研究证明了溶栓治疗人工瓣膜血栓形成的可行性、安全性和有效性。它还强调了系列多普勒超声心动图在指导治疗持续时间和评估其疗效方面的作用。
