Sakr S A, Abdel-Shakour H, Ramadan M M
Acta Clin Belg. 2015 Jun;70(3):159-66. doi: 10.1179/2295333714Y.0000000107. Epub 2014 Dec 10.
This study aims to evaluate the clinical outcome of fibrinolytic treatment of prosthetic valve thrombosis (PVT) with 'streptokinase' as a first line treatment for these cases.
The study group was 20 consecutive patients (10 females) diagnosed with PVT. The protocol for streptokinase administration was either accelerated (intravenous infusion of 0.5 million IU over 30 minutes followed by 0.15 million IU/h) or conventional (intravenous infusion of 0.25 million IU over 30 minutes followed by 0.15 million IU/h). Success of fibrinolytic therapy was defined as complete restoration of valve function in the presence or absence of complications.
Eighteen patients (90%) had mitral PVT and two (10%) had aortic PVT. Thrombolytic therapy with streptokinase was successful in all but one case, with a total mortality of four cases (20%). In PVT episodes, before streptokinase therapy, the prosthetic valve areas (in all cases, mitral and aortic positions) were 0.82 ± 0.21, 0.83 ± 0.21, and 0.73 ± 0.18 cm²; and the peak and mean transvalvular gradients were 38.7 ± 16.7 and 25.4 ± 8.7, 34.1 ± 8.8 and 23.2 ± 5.4, and 80.0 ± 14.1 and 45.0 ± 7.1 mmHg, respectively. After streptokinase therapy, the prosthetic valve area and peak and mean transvalvular gradients improved significantly (for all cases, mitral and aortic positions: valve area 2.17 ± 0.58, 2.21 ± 0.61, and 1.85 ± 0.07 cm², peak gradient 18.7 ± 11.0, 16.4 ± 7.7, and 39.0 ± 18.4, and mean gradient 9.6 ± 7.1, 8.2 ± 5.3, and 22.0 ± 11.3 mmHg, respectively; paired t-test, P<0.001 for pre- versus post-streptokinase infusion for all variables).
Fibrinolytic therapy using streptokinase was an effective therapeutic strategy for the management of PVT and is a reasonable alternative to surgery.
本研究旨在评估以链激酶作为人工瓣膜血栓形成（PVT）一线治疗方法的溶栓治疗的临床结果。
研究组为连续20例被诊断为PVT的患者（10例女性）。链激酶给药方案为加速给药（30分钟内静脉输注50万IU，随后以每小时15万IU输注）或常规给药（30分钟内静脉输注25万IU，随后以每小时15万IU输注）。溶栓治疗成功的定义为无论有无并发症，瓣膜功能完全恢复。
18例患者（90%）为二尖瓣PVT，2例（10%）为主动脉瓣PVT。除1例患者外，链激酶溶栓治疗均成功，总死亡率为4例（20%）。在PVT发作时，链激酶治疗前，人工瓣膜面积（所有病例，二尖瓣和主动脉瓣位置）分别为0.82±0.21、0.83±0.21和0.73±0.18cm²；跨瓣膜峰值和平均梯度分别为38.7±16.7和25.4±8.7、34.1±8.8和23.2±5.4、80.0±14.1和45.0±7.1mmHg。链激酶治疗后，人工瓣膜面积、跨瓣膜峰值和平均梯度均有显著改善（所有病例，二尖瓣和主动脉瓣位置：瓣膜面积分别为2.17±0.58、2.21±0.61和1.85±0.07cm²，峰值梯度分别为18.7±11.0、16.4±7.7和39.0±18.4，平均梯度分别为9.6±7.1、8.2±5.3和22.0±11.3mmHg；配对t检验，所有变量链激酶输注前后P<0.001）。
使用链激酶的溶栓治疗是治疗PVT的有效策略，是手术的合理替代方法。
