Isoda S, Kondo J, Imoto K, Kajiwara H, Matsumoto A
First Department of Surgery, Yokohama City University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Jun;40(6):1006-9.
A 56-year-old male, who had mitral stenosis and gout, underwent mitral valve replacement with the Björk-Shiley valve prosthesis. Four years after the surgery, the patient suddenly became dyspneic on exercise due to malfunctioning valve. Thrombosis was found on the prosthesis, which was replaced again by Björk-Shiley valve. Thrombotest value had been satisfactorily controlled at 12.8 +/- 4.2% with warfarin since the first surgery. Dilazep chlorate also had been prescribed. Hyperuricemia had been controlled with allopurinol. In spite of these combined medical therapy, thrombosed valve recurred. Clotted prosthesis was superseded by Carpentier-Edwards Bioprosthesis. Enhancement of platelet function of the patients with gout and hyperuricemia has been reported. Gout in this case might have influence on the recurrent episodes of thrombosis. Monitoring of platelet function would be necessary in follow-up of a patients with gout and valve replacement.
一名56岁男性,患有二尖瓣狭窄和痛风,接受了使用 Björk-Shiley 瓣膜假体的二尖瓣置换术。术后四年,患者因瓣膜功能故障在运动时突然出现呼吸困难。在假体上发现血栓形成,再次用 Björk-Shiley 瓣膜进行了置换。自首次手术以来,使用华法林时血栓试验值一直令人满意地控制在12.8 +/- 4.2%。还开具了氯氮卓。高尿酸血症已用别嘌醇控制。尽管采取了这些联合药物治疗,血栓形成的瓣膜仍复发。凝块的假体被Carpentier-Edwards生物假体取代。已有报道称痛风和高尿酸血症患者的血小板功能增强。该病例中的痛风可能对血栓形成的复发发作有影响。在痛风和瓣膜置换患者的随访中,有必要监测血小板功能。