Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, NT, Australia.
Royal Darwin Hospital, Intensive Care Unit and Department of Cardiology, Darwin, NT, Australia.
Heart Lung Circ. 2020 Mar;29(3):469-474. doi: 10.1016/j.hlc.2019.07.005. Epub 2019 Aug 2.
Prosthetic valve thrombosis (PVT) is an uncommon but serious cause of morbidity and mortality after cardiac valve implantation. The most common cause leading to PVT is inadequate anticoagulation. Royal Darwin Hospital is a major referral centre for the Top End of Australia and is unique in having a high burden of rheumatic heart disease (RHD) requiring valve surgery, issues with adherence with oral anticoagulants, and the absence of onsite cardiothoracic facility.
We report clinical characteristics and outcomes of consecutive patients presenting with PVT to a single centre without on-site cardiothoracic surgery.
Thirty-two (32) episodes involving 21 patients were retrospectively identified between 2000 and 2017. Our cohort had an average age of 37 years. Nineteen (19) patients were of Aboriginal or Torres Strait Islander descent. All valves were mechanical, except for one bioprosthetic mitral valve, with average time from implantation to initial PVT 5.1 years. The majority of patients were in New York Heart Association (NYHA) class III and IV (6%, and 66%, respectively). Anti-coagulation was sub-therapeutic in 88% of presentations. Eleven (11) (34%) presentations were recurrent PVT involving eight patients. Twenty-six (26) (82%) episodes were treated with thrombolytic therapy which achieved complete success in 65% and partial success in 19%. Five (5) patients received a second dose of the lytic agent. Of the four patients not responding to thrombolytic therapy, two died and two were urgently transferred to a facility with on-site cardiothoracic surgery. Five (5) out of 32 episodes resulted in death (16%) with overall mortality 24% for the cohort over the entire time period. Thrombolytic therapy was associated with five major bleeding episodes (16%) including two fatal bleeds.
Prosthetic valve thrombosis is a rare but life-threatening complication of prosthetic valves, with the vast majority of patients found to be inadequately anticoagulated. Despite differences in thrombolytic agents these were successful in the majority of patients.
人工心脏瓣膜血栓形成（PVT）是心脏瓣膜植入术后发病率和死亡率升高的一个不常见但严重的原因。导致 PVT 的最常见原因是抗凝不足。达尔文皇家医院是澳大利亚北部地区的一个主要转诊中心，其特点是风湿性心脏病（RHD）负担沉重，需要瓣膜手术，口服抗凝剂的依从性存在问题，并且没有现场心胸设施。
我们报告了在没有现场心胸外科手术的单一中心连续出现 PVT 的患者的临床特征和结局。
2000 年至 2017 年期间，共回顾性确定了 21 名患者的 32 个（32）个 PVT 发作。我们的队列平均年龄为 37 岁。19 名（19）患者为土著或托雷斯海峡岛民。除了一个生物假体二尖瓣外，所有瓣膜均为机械瓣膜，从植入到首次 PVT 的平均时间为 5.1 年。大多数患者为纽约心脏协会（NYHA）心功能分级 III 级和 IV 级（分别为 6%和 66%）。在 88%的情况下，抗凝治疗效果不理想。11 例（34%）为 8 例患者的复发性 PVT。26 例（26%）采用溶栓治疗，65%达到完全成功，19%达到部分成功。5 例（5 例）患者接受了第二种溶栓剂。在对溶栓治疗无反应的 4 名患者中，2 人死亡，2 人紧急转至有现场心胸外科手术的机构。在 32 个发作中有 5 个（16%）导致死亡（16%），整个时间段内该队列的总死亡率为 24%。溶栓治疗与 5 例大出血事件（16%）相关，其中包括 2 例致命性出血。
人工心脏瓣膜血栓形成是人工心脏瓣膜的一种罕见但危及生命的并发症，绝大多数患者发现抗凝不足。尽管溶栓剂存在差异，但在大多数患者中都取得了成功。
