Ari Hatem, Dogan Abdullah, Ceviker Kadir, Aksoy Fatih, Arslan Akif, Varol Ercan
J Heart Valve Dis. 2015 May;24(3):353-9.
Prosthetic valve thrombosis (PVT) is a rare but serious complication of the prosthetic heart valve. Although recent guidelines generally recommend surgical treatment as the main option for patients with obstructive left-sided PVT, thrombolytic therapy (TT) may offer another attractive approach. There is also no consensus on the type, dose and route of administration of thrombolytic agents. The present study included a small series of patients with low-dose, slow infusion tissue-type plasminogen activator (tPA) to treat PVT in the mitral position.
Eight consecutive episodes of mitral PVT (one woman was pregnant) in seven patients were treated with low-dose (25 mg), slow infusion (within 6 h) tPA, if needed, with repeat sessions of TT (with the same protocol up to a total dose of 150 mg) until a satisfactory result was achieved.
The cause of PVT was inadequate anticoagulation with warfarin or low-molecular-weight heparin in all patients on admission. A complete resolution of hemodynamic instability and echocardiographic abnormalities was observed in all cases, without mortality. In addition, there were no thromboembolic and major hemorrhagic complications in the case series.
These findings suggest that low-dose, slow infusion tPA may be applicable to bileaflet mitral PVT in relatively stable patients, and may represent a therapeutic option to surgery.
人工瓣膜血栓形成（PVT）是人工心脏瓣膜一种罕见但严重的并发症。尽管近期指南通常推荐手术治疗作为左侧梗阻性PVT患者的主要选择，但溶栓治疗（TT）可能提供另一种有吸引力的方法。关于溶栓药物的类型、剂量和给药途径也没有共识。本研究纳入了一小系列采用低剂量、缓慢输注组织型纤溶酶原激活剂（tPA）治疗二尖瓣位PVT的患者。
7例患者连续发生8次二尖瓣PVT发作（1例女性患者为孕妇），采用低剂量（25mg）、缓慢输注（6小时内）tPA治疗，必要时重复进行TT疗程（采用相同方案，总剂量达150mg），直至取得满意结果。
所有患者入院时PVT的病因均为华法林或低分子肝素抗凝不足。所有病例均观察到血流动力学不稳定和超声心动图异常完全缓解，无死亡病例。此外，该病例系列中未出现血栓栓塞和严重出血并发症。
这些发现表明，低剂量、缓慢输注tPA可能适用于病情相对稳定的双叶二尖瓣PVT患者，可能是一种替代手术的治疗选择。
