Bade Arun Shivajirao, Shaikh Shakil Sattar Ahmed, Khemani Hemant, Singh Gurkirat, Bansal Narender Omprakash
Department of Cardiology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai India.
Cardiol Res. 2018 Jun;9(3):161-164. doi: 10.14740/cr708w. Epub 2018 Jun 6.
Thrombosis is a complication of prosthetic valves on oral anticoagulants which is associated with significant morbidity and mortality. A re-operation carries a substantial risk, with mortality rate from 10% to 15% in selected series, which may be 2- or 3-folds higher in critically ill patients. This study conducted in a tertiary care cardiology unit aimed to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves.
As a prospective observational study, clinical symptoms and fluoroscopy were the mainstay in diagnosis of stuck mitral valve. Gradient across the valve by transthoracic echocardiography was used to monitor the therapy every 6 h. Fall of mean gradient more than 50% was considered as successful thrombolysis. And final results were again checked by fluoroscopy with documentation of improved leaflet movement.
Totally we studied 34 patients. Patients receiving thrombolytic therapy with streptokinase achieved an overall 91.2% freedom from a repeat operation or major complications, a large subcutaneous hematoma occurred in one ( 2.9%), reoperation required in two due to failure of treatment (5.9%), allergic reaction in one (2.9%), one patient developed transient neurologic dysfunction (2.9%) and one patient died during therapy due to refractory cardiogenic shock(2.9%). All patients including those with delayed presentation (> 14 days) and hemodynamically unstable patients had good results similar to those who presented within 14 days and hemodynamically stable. Mortality was higher in unstable patients and reoperation was higher with delayed presentation.
Thrombolysis with streptokinase is highly successful and safe therapy in hemodynamically stable as well as unstable patients, or those with early or delayed presentation with stuck bileaflet mitral valves, especially in centers where round the clock cardiothoracic surgery backup is not available.
血栓形成是口服抗凝剂治疗人工瓣膜时的一种并发症，与显著的发病率和死亡率相关。再次手术风险很大，在特定系列研究中死亡率为10%至15%，在危重症患者中可能高出2至3倍。本研究在一家三级护理心脏病科进行，旨在评估溶栓治疗卡在二尖瓣双叶心脏瓣膜中的有效性和安全性。
作为一项前瞻性观察性研究，临床症状和荧光透视是诊断卡瓣二尖瓣的主要手段。经胸超声心动图测量瓣膜两端的压差，每6小时用于监测治疗效果。平均压差下降超过50%被视为溶栓成功。最终结果再次通过荧光透视检查，并记录瓣叶活动改善情况。
我们共研究了34例患者。接受链激酶溶栓治疗的患者总体上有91.2%免于再次手术或发生重大并发症，1例（2.9%）出现大面积皮下血肿，2例（5.9%）因治疗失败需要再次手术，1例（2.9%）出现过敏反应，1例患者出现短暂性神经功能障碍（2.9%），1例患者在治疗期间因难治性心源性休克死亡（2.9%）。所有患者，包括那些就诊延迟（>14天）和血流动力学不稳定的患者，都取得了与就诊14天内且血流动力学稳定的患者相似的良好结果。不稳定患者的死亡率较高，就诊延迟患者的再次手术率较高。
对于血流动力学稳定和不稳定的患者，以及双叶二尖瓣卡瓣早期或延迟就诊的患者，链激酶溶栓是一种非常成功且安全的治疗方法，尤其是在没有全天候心胸外科后备支持的中心。
