Kothari Jignesh, Patel Kartik, Brahmbhatt Bhavin, Baria Kinnaresh, Talsaria Malkesh, Patel Sanjay, Tailor Sandeep
Professor, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
Assistant Professor, Department of Cardiothoracic and Vascular Surgery, U. N. Mehta, Institute of Cardiology and Research Center , New Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India .
J Clin Diagn Res. 2016 Nov;10(11):PC01-PC03. doi: 10.7860/JCDR/2016/20209.8913. Epub 2016 Nov 1.
Prosthetic Valve Thrombosis (PVT) remains a significant cause of morbidity and mortality after valve replacement. Although surgical treatment is usually preferred as life-saving in cases of obstructive PVT, optimal treatment is yet to be decided.
To evaluate risk factors and outcome of the patients undergoing redo mitral valve surgery for acute PVT.
Between January 2012 and February 2015, 65 patients underwent redo surgery for obstructive PVT of mitral valve in Department of Cardiothoracic Surgery, UN Mehta Institute of Cardiology & Research Centre. Patients having acute PVT of aortic valve or combined aortic and mitral valve were excluded. Pre-operative, intra-operative and post-operative factors affecting the outcome as well as follow-up data were measured.
There were total 65 patients, 17 males and 48 females. Most common presenting symptom was dyspnea (100%), followed by palpitation (57.88%) and fatigue (29.45%). Total mortality was 29.2% (19/65). Mortality rate was significantly higher (16/35, 46%) in patients with direct surgery (Group-2) as compared to those with failed thrombolysis (3/30, 10%) (Group-1). Mortality was also significantly higher in patients presented with New York Heart Association (NYHA) III/IV class as compared to those presented with NYHA I/II class (p=0.02). All survived patients are NYHA Class I-II in follow-up with mean follow-up period was 24 ± 9 months.
PVT still remains a challenging problem in a post-operative patient with a high mortality independent of treatment modality. Though life-saving, the surgical management of this condition still carries a high risk in haemodynamically unstable and in NYHA class III/IV patients.
人工瓣膜血栓形成（PVT）仍然是瓣膜置换术后发病和死亡的重要原因。尽管在梗阻性PVT病例中，手术治疗通常被视为挽救生命的首选方法，但最佳治疗方案仍有待确定。
评估接受二尖瓣再次手术治疗急性PVT患者的危险因素和预后。
2012年1月至2015年2月期间，65例患者在UN梅塔心脏病学与研究中心心胸外科接受了二尖瓣梗阻性PVT再次手术。排除患有主动脉瓣急性PVT或主动脉瓣与二尖瓣联合急性PVT的患者。测量影响预后的术前、术中和术后因素以及随访数据。
共有65例患者，男性17例，女性48例。最常见的症状是呼吸困难（100%），其次是心悸（57.88%）和疲劳（29.45%）。总死亡率为29.2%（19/65）。与溶栓失败的患者（3/30，10%）（第1组）相比，直接手术的患者（第2组）死亡率显著更高（16/35，46%）。纽约心脏协会（NYHA）III/IV级患者的死亡率也显著高于NYHA I/II级患者（p=0.02）。所有存活患者在随访中均为NYHA I-II级，平均随访期为24±9个月。
PVT在术后患者中仍然是一个具有挑战性的问题，死亡率高，与治疗方式无关。尽管手术治疗可挽救生命，但在血流动力学不稳定和NYHA III/IV级患者中，这种疾病的手术管理仍然具有高风险。
