Chandrakasu Arumugam, Jayachandran Avinash, Gopinath Nayar Pradeep, Meyyappan Chokkalingam, Narayan Ganesh, Basha Abdul Bari Ahamed, Johnson Samuel Prince
Department of Cardiology, Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Chennai, Tamil Nadu, India. Electronic correspondence:
Department of Cardiology, Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Chennai, Tamil Nadu, India.
J Heart Valve Dis. 2017 May;26(3):344-348.
Thrombosis of a mechanical prosthetic heart valve is a potentially life-threatening complication associated with a high mortality. Although thrombolytic therapy has been considered highly beneficial in this situation, very few studies have been conducted to monitor the effectiveness of such thrombolytic therapy among Asian populations. Hence, the study aim was to evaluate the clinical profile, efficacy and safety of the thrombolytic agent streptokinase (SK) in patients with obstructive thrombosis of a left-sided mechanical heart valve.
Patients (n = 30) with left-sided mechanical heart valve thrombosis (LSMHVT) who had been managed with SK during the past four years were included in this retrospective study. Clinical features such as presenting symptoms based on NYHA functional class, prosthetic valve position, oral anticoagulant compliance, International Normalized Ratio (INR) and imaging methods including fluoroscopy, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were evaluated. In addition, the effectiveness and complications of SK were analyzed.
The majority of patients presented with advanced NYHA class (III and IV, each 40%). Obstructive thromboses were observed at the mitral prosthesis in 70% of cases, at the aortic prosthesis in 27%, and at both valves in 3%. All patients underwent TTE, but fluoroscopy was used more often than TEE. Despite compliance with oral anticoagulation therapy, a sub-therapeutic INR was observed in 40% of cases at the time of presentation. Overall, thrombolysis was successful in 80% of patients using intravenous SK, with 100% success in patients in NYHA classes I-III and 42% for NYHA class IV. Moreover, embolic complications occurred in only a small number of patients.
In patients with obstructive thrombosis of LSMHVT, intravenous SK was effective and should be considered as first choice in patients in NYHA classes I-III, and as an acceptable alternative in those in NYHA class IV.
机械人工心脏瓣膜血栓形成是一种潜在的危及生命的并发症，死亡率很高。尽管溶栓治疗在这种情况下被认为非常有益，但针对亚洲人群监测此类溶栓治疗效果的研究却很少。因此，本研究的目的是评估溶栓药物链激酶（SK）在左侧机械心脏瓣膜阻塞性血栓形成患者中的临床特征、疗效及安全性。
本回顾性研究纳入了过去四年中接受SK治疗的左侧机械心脏瓣膜血栓形成（LSMHVT）患者（n = 30）。评估了临床特征，如基于纽约心脏协会（NYHA）功能分级的症状表现、人工瓣膜位置、口服抗凝药依从性、国际标准化比值（INR）以及包括荧光透视、经胸超声心动图（TTE）和经食管超声心动图（TEE）在内的成像方法。此外，还分析了SK的有效性和并发症。
大多数患者表现为NYHA高级别（III级和IV级，各占40%）。70%的病例在二尖瓣人工瓣膜处观察到阻塞性血栓，27%在主动脉人工瓣膜处，3%在两个瓣膜处均有。所有患者均接受了TTE检查，但荧光透视的使用频率高于TEE。尽管患者依从口服抗凝治疗，但40%的病例在就诊时INR未达到治疗水平。总体而言，静脉注射SK使80%的患者溶栓成功，NYHA I - III级患者的成功率为100%，NYHA IV级患者为42%。此外，只有少数患者发生栓塞并发症。
在LSMHVT阻塞性血栓形成患者中，静脉注射SK有效，对于NYHA I - III级患者应视为首选，对于NYHA IV级患者可作为可接受的替代方案。
