Hata T, Namba H, Sone Y, Kuinose M, Murakami T, Taniguchi G
Department of Cardiovascular Surgery, Cardiovascular Center Sakakibara Hospital, Okayama, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Feb;39(2):236-9.
Because valve thrombosis occurred after the tricuspid valve replacement with the mechanical valve, we performed replacement of the mechanical valve with the bovine pericardial valve in two cases. Case 1: The patient, at 13 years old, received open-heart surgery to correct infundibular stenosis. At 23 years of age, decortication and tricuspid valve replacement (TVR) with a phi 31 mm Björk-Shiley valve were performed due to constrictive pericarditis and tricuspid regurgitation developed after the initial operation. Thrombosis of the mechanical valve occurred after the TVR. Treatment with urokinase for the thrombolytic therapy failed to improve the valve opening. Finally 12 years after the TVR, replacement of the mechanical valve with a phi 27 mm Carpentier-Edwards bovine pericardial valve was performed. Case 2: The patient, at 21 years old, received open-heart surgery to close an atrial septal defect. At 40 years of age, mitral and tricuspid valve replacements were performed because regurgitation developed in both valves. The mitral and tricuspid valves were replaced with phi 27 mm and 31 mm St. Jude Medical valves, respectively. Thrombosis of the mechanical valve used for the TVR occurred 2 months after the replacement. The mechanical valve was replaced with a phi 27 mm Carpentier-Edwards bovine pericardial valve. In both cases, subjective symptoms improved and prosthetic valve complications did not occur after re-replacement with the bovine pericardial valve. These cases suggested that for TVR a bovine pericardial valve of sufficient size would be better to select than a mechanical valve.
由于在机械瓣膜置换三尖瓣后发生了瓣膜血栓形成，我们对两例患者进行了机械瓣膜置换为牛心包瓣膜的手术。病例1：患者13岁时接受了开心手术以纠正漏斗部狭窄。23岁时，因初次手术后发生缩窄性心包炎和三尖瓣反流，进行了心包剥脱术和用31毫米Björk-Shiley瓣膜置换三尖瓣（TVR）。TVR后机械瓣膜发生血栓形成。用尿激酶进行溶栓治疗未能改善瓣膜开放情况。最终在TVR后12年，用27毫米Carpentier-Edwards牛心包瓣膜置换了机械瓣膜。病例2：患者21岁时接受了开心手术以闭合房间隔缺损。40岁时，因二尖瓣和三尖瓣均出现反流，进行了二尖瓣和三尖瓣置换术。二尖瓣和三尖瓣分别用27毫米和31毫米圣犹达医疗瓣膜进行了置换。用于TVR的机械瓣膜在置换后2个月发生血栓形成。用27毫米Carpentier-Edwards牛心包瓣膜置换了机械瓣膜。在这两例中，主观症状均有改善，且再次置换为牛心包瓣膜后未出现人工瓣膜并发症。这些病例表明，对于TVR，选择尺寸足够的牛心包瓣膜比机械瓣膜更好。
