Miller Matthew M, Hipp Robert, Matsumura Martin E
Department of Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA 18103, USA.
Interact Cardiovasc Thorac Surg. 2008 Dec;7(6):1167-9. doi: 10.1510/icvts.2007.172155. Epub 2008 Jul 31.
We report a case of a 57-year-old patient with a history of a Starr-Edwards mitral valve prosthesis and DeBakey-Surgitool aortic valve prosthesis implanted 30 years ago who presented with symptoms consistent with class IV heart failure. The patient had been on no anticoagulation for approximately 30 years secondary to recurrent epistaxis occurring two years after starting warfarin therapy postoperatively. Throughout the patient's lifetime he experienced no thromboembolic complications from the lack of anticoagulation, despite developing concomitant atrial fibrillation approximately ten years prior to admission. In place of warfarin the patient had substituted large doses of aspirin. A workup revealed normal function of the mechanical valves for this extensive period.
我们报告一例57岁患者，30年前植入了斯塔尔-爱德华兹二尖瓣人工瓣膜和德巴基-苏尔吉托尔主动脉瓣人工瓣膜，现出现符合IV级心力衰竭的症状。该患者在术后开始使用华法林治疗两年后因反复鼻出血，已停用抗凝治疗约30年。尽管在入院前约十年出现了并发房颤，但该患者一生中未因未进行抗凝治疗而出现血栓栓塞并发症。该患者用大剂量阿司匹林替代了华法林。检查显示，在这一较长时期内机械瓣膜功能正常。
