Raboi A, Al-Motarreb A, Al-Kanadi A, Abdulmughni A A, Kadi A
Cardiac Centre, Al-Thawrah Hospital, Faculty of Medicine, Sana'a University, Yemen.
Heart Views. 2010 Jun;11(2):47-51. doi: 10.4103/1995-705X.73207.
Rheumatic heart disease is the most common cardiac disease in Yemen. It is associated with high morbidity and mortality. Valve replacement is the most common open heart surgery procedure in our cardiac center. The use of mechanical valves remains burdened with serious complications such as thrombosis. Valve thrombosis is still associated with high mortality(]) The reported mortality rate of the redo operation ranges from 8 to 20% and up to 37-54% in critically ill patients.
The aim of the present study was to investigate mechanical valve obstruction among Yemeni patients.
Between January 2003 and April 2007, 2794 patients underwent prosthetic valve replacement in our center, Al-Thawra Hospital. Of those patients, 129 (4.6%) underwent reoperation for te obstructive mechanical valve. Patients with clinical suspicion of prosthetic valve obstruction (PVO) were admitted emergently to the CCU and the diagnosis was confirmed with echocardiography. All patients had heart failure; 95% of them were in NYHA class IV. All were transferred directly from the CCU to the operating room. The mean age was 34.8 ± 13.4 years. Two patients received preoperative thrombolytic therapy that was not successful. Obstruction involved the mitral valve prosthesis in 47 (36.4%); the aortic prosthesis in 16 (12.4%) patients; both valves in 21 (16.3%) patients; mitral valve replacement with tricuspid valve repair in 22(17%); double valve replacement with tricuspid valve repair in 1 (0.8%); redo mitral valve replacement with aortic valve cleaning in 7 (5.4%) cases; aortic valve cleaning in 5 (3.9%) patients; mitral valve cleaning in 5 (3.9%); and 5 (3.9%) patients had redo mitral with aortic replacement.
The operations were performed urgently. The etiology of the obstruction was thrombus in 111 (86%), pannus formation in 4 (3%), pannus and thrombus in 6 (4.8%), vegetation in 7 (5.4%) patients, and interposition of suturing materials in 1 (0.8%) patient. The in- hospital mortality was 23/129 (17.8%).
The incidence of prosthetic valve obstruction remains high in Yemen. The vast majority of the patients who are referred to our hospital come from remote provinces in the country where regular INR measurement is not readily available. For those who are living in areas without good medical care, certain measures are necessary to avoid this disastrous complication: (1) good patient education, (2) free INR testing and free anticoagulant drugs such as warfarin; and (3) use of tissue rather than mechanical valves.
风湿性心脏病是也门最常见的心脏病。它与高发病率和高死亡率相关。瓣膜置换是我们心脏中心最常见的心脏直视手术。机械瓣膜的使用仍然伴随着严重并发症，如血栓形成。瓣膜血栓形成仍然与高死亡率相关（）再次手术的报告死亡率在8%至20%之间，危重症患者高达37% - 54%。
本研究的目的是调查也门患者中机械瓣膜梗阻情况。
2003年1月至2007年4月期间，2794例患者在我们的中心——塔瓦拉医院接受了人工瓣膜置换术。在这些患者中，129例（4.6%）因机械瓣膜梗阻接受了再次手术。临床怀疑人工瓣膜梗阻（PVO）的患者被紧急收入重症监护病房（CCU），并通过超声心动图确诊。所有患者均患有心力衰竭；其中95%为纽约心脏协会（NYHA）IV级。所有患者均直接从CCU转入手术室。平均年龄为34.8±13.4岁。2例患者接受术前溶栓治疗但未成功。梗阻累及二尖瓣人工瓣膜47例（36.4%）；主动脉人工瓣膜16例（12.4%）；两个瓣膜均受累21例（16.3%）；二尖瓣置换联合三尖瓣修复22例（17%）；双瓣膜置换联合三尖瓣修复1例（0.8%）；再次二尖瓣置换联合主动脉瓣清理7例（5.4%）；主动脉瓣清理5例（3.9%）；二尖瓣清理5例（3.9%）；5例（3.9%）患者接受再次二尖瓣置换联合主动脉瓣置换。
手术均为急诊进行。梗阻的病因是血栓形成111例（86%），血管翳形成4例（3%），血管翳和血栓形成6例（4.8%），赘生物形成7例（5.4%），缝合材料嵌入1例（0.8%）。住院死亡率为23/129（17.8%）。
也门人工瓣膜梗阻的发生率仍然很高。转诊至我院的绝大多数患者来自该国偏远省份，那里无法轻易进行常规国际标准化比值（INR）测量。对于那些生活在医疗条件不佳地区的患者，有必要采取某些措施来避免这种灾难性并发症：（1）对患者进行良好的教育；（2）免费进行INR检测和免费提供抗凝药物，如华法林；（3）使用生物瓣膜而非机械瓣膜。
