Sugawa M, Ohkubo S, Nakamura M, Isaka N, Konishi T, Nakano T
Department of Internal Medicine, Saiseikai Matsuzaka Hospital, Mie, Japan.
Jpn J Med. 1988 May;27(2):200-2. doi: 10.2169/internalmedicine1962.27.200.
A 15-year-old girl with a prosthetic aortic valve had recurrent episodes of prosthetic valve thrombosis. She had had an emergency operation that included aortic valve replacement because of congestive heart failure secondary to aortic regurgitation due to annuloaortic ectasia complicated by aortitis syndrome. She had been on warfarin. On each admission, fibrinolytic therapy was given to her because she refused reoperation. The therapy was successful and without any complications. After the Thrombotest index was controlled between 6% and 15%, prosthetic valve thrombosis did not recur. The values of beta-thromboglobulin and platelet factor 4 were also kept within the normal range. We concluded that: (1) in circumstances that prevented surgery, fibrinolytic therapy was successful. (2) Adequate anticoagulant therapy prevented recurrence of prosthetic valve thrombosis. (3) Elevations of beta-thromboglobulin and platelet factor 4 proved to be diagnostic indicators for prosthetic valve thrombosis.
一名患有人工主动脉瓣的15岁女孩反复出现人工瓣膜血栓形成。她曾因瓣环主动脉扩张合并主动脉炎综合征导致主动脉瓣反流继发充血性心力衰竭而接受了包括主动脉瓣置换在内的急诊手术。她一直在服用华法林。每次入院时，由于她拒绝再次手术，所以都对她进行了纤维蛋白溶解疗法。该疗法取得了成功且未出现任何并发症。在凝血酶原时间指数控制在6%至15%之间后，人工瓣膜血栓形成未再复发。β-血小板球蛋白和血小板因子4的值也保持在正常范围内。我们得出结论：（1）在无法进行手术的情况下，纤维蛋白溶解疗法是成功的。（2）充分的抗凝治疗可预防人工瓣膜血栓形成的复发。（3）β-血小板球蛋白和血小板因子4的升高被证明是人工瓣膜血栓形成的诊断指标。
