Norkienė Ieva, Kažukauskienė Ieva, Samalavičius Robertas, Ručinskas Kęstutis
Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Center of Cardiology, Vilnius University Hospital Santariškių Clinics.
Acta Med Litu. 2016;23(1):1-4. doi: 10.6001/actamedica.v23i1.3263.
Prosthetic valve thrombosis (PVT) is a rare and fatal complication requiring immediate treatment. Optimal management of the left-sided obstructive PVT is still controversial and depends on patient's status, estimated risk of surgery, thrombus location and size, and clinician's experience. We report a case of a 71-year-old woman, presenting with signs of cardiogenic shock. Transesophageal echoscopy was used to diagnose acute obstructive thrombosis of the mechanical aortic valve. Concomitant coronary graft thrombosis was suspected due to signs of acute myocardial infarction. Thrombolysis with alteplase and subsequent stenting of the venous graft lead to successful resolution of the thrombotic lesions and a favourable patient outcome. Fibrinolytic therapy followed by angioplasty is a rational treatment alternative for inoperable or high risk patients in the case of concomitant mechanical valve and graft thrombosis.
人工瓣膜血栓形成（PVT）是一种罕见的致命并发症，需要立即治疗。左侧阻塞性PVT的最佳治疗方案仍存在争议，且取决于患者的状况、手术估计风险、血栓位置和大小以及临床医生的经验。我们报告一例71岁女性病例，该患者出现心源性休克体征。经食管超声心动图用于诊断机械主动脉瓣急性阻塞性血栓形成。由于急性心肌梗死的体征，怀疑同时存在冠状动脉移植血栓形成。使用阿替普酶进行溶栓治疗，随后对静脉移植物进行支架置入，成功解决了血栓性病变，患者预后良好。对于伴有机械瓣膜和移植物血栓形成的无法手术或高危患者，溶栓治疗后行血管成形术是一种合理的治疗选择。
