Kontos G J, Schaff H V, Orszulak T A, Puga F J, Pluth J R, Danielson G K
Section of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Ann Thorac Surg. 1989 Jul;48(1):60-5. doi: 10.1016/0003-4975(89)90177-x.
Twenty-seven patients underwent reoperation because of thrombotic obstruction of a disc-type cardiac valve prosthesis. Preoperative clinical features included effort dyspnea in 81%, new-onset angina in 44%, a new murmur in 89%, and an abnormal opening or closing sound associated with the prosthetic valve in 56%. Symptoms were present for 1 week or more before reoperation in 86%, although many patients were referred only after acute exacerbation of heart failure and development of pulmonary edema. Noninvasive studies confirmed prosthetic valve malfunction in only 33%, but cardiac catheterization documented thrombotic obstruction in all 15 patients in whom it was performed. In 14 of the 27 patients, prothrombin time was in the therapeutic range at the time of admission. Prompt reoperation for valve replacement or thrombectomy was performed with an operative mortality of 11%, and long-term outcome was satisfactory in all but 1 hospital survivor. These findings emphasize the importance of considering the diagnosis of thrombosed heart valves in patients with mechanical heart valves who are seen with nonspecific symptoms.
27例患者因盘式心脏瓣膜假体血栓形成阻塞而接受再次手术。术前临床特征包括81%的患者有劳力性呼吸困难，44%的患者有新发心绞痛，89%的患者有新出现的杂音，56%的患者有与人工瓣膜相关的异常开闭音。86%的患者在再次手术前症状已持续1周或更长时间，尽管许多患者仅在心力衰竭急性加重和肺水肿发生后才被转诊。非侵入性检查仅在33%的患者中证实人工瓣膜功能障碍，但心脏导管检查在所有进行检查的15例患者中均记录到血栓形成阻塞。27例患者中有14例在入院时凝血酶原时间处于治疗范围内。迅速进行瓣膜置换或血栓切除术的再次手术，手术死亡率为11%，除1例住院幸存者外，所有患者的长期预后均令人满意。这些发现强调了在出现非特异性症状的机械心脏瓣膜患者中考虑诊断心脏瓣膜血栓形成的重要性。
