Paediatric Cardiology Department, King Faisal Specialist Hospital and Research centre, Jeddah, Saudi Arabia.
Department of Paediatrics, Faculty of medicine, Cairo University, Cairo, Egypt.
Cardiol Young. 2023 May;33(5):747-753. doi: 10.1017/S1047951122001652. Epub 2022 Jun 3.
The incidence of prosthetic valve implantation is increasing in the paediatric population. Prosthetic valve thrombosis leading to obstruction could potentially be a life-threatening complication. There is a debate regarding optimal management of this complication, and there is limited use of thrombolytic therapy in childhood in the setting of valve thrombosis.
We aim to share our experience of successfully using fibrinolytic therapy in terms of alteplase for paediatric prosthetic mitral valve thrombosis and to propose a management algorithm.
This retrospective analysis of the database was conducted at our hospital including patients who underwent thrombolysis (alteplase) for prosthetic mitral valve thrombosis from June, 2011 to June, 2021. A total of 10 patients with 20 attempts of alteplase infusion were found in our record.
Alteplase was successful in 19 attempts to relieve valve thrombosis. The safe and effective dose of alteplase was between 0.1 and 0.3 mg/kg/hour. There were no associated major bleeding complications and alteplase was administered either by central or peripheral line.
Thrombolysis by alteplase infusion was found to be successful in relief of prosthetic mitral valve thrombosis in paediatric population without major bleeding complications.
在儿科人群中，人工瓣膜植入的发病率正在增加。人工瓣膜血栓形成导致梗阻可能是危及生命的并发症。对于这种并发症的最佳治疗方法存在争议，并且在瓣膜血栓形成的情况下，儿童溶栓治疗的应用有限。
我们旨在分享我们在使用纤维蛋白溶解疗法（阿替普酶）治疗儿科人工二尖瓣血栓形成方面的经验，并提出一种管理算法。
对我院数据库进行回顾性分析，包括 2011 年 6 月至 2021 年 6 月期间接受人工二尖瓣血栓形成溶栓（阿替普酶）治疗的患者。在我们的记录中发现了 10 例患者共 20 次阿替普酶输注尝试。
阿替普酶在 19 次尝试中成功缓解了瓣膜血栓形成。阿替普酶的安全有效剂量为 0.1 至 0.3mg/kg/小时之间。没有发生与主要出血并发症相关的并发症，阿替普酶通过中心或外周线给药。
阿替普酶输注溶栓被发现可成功缓解儿科人群的人工二尖瓣血栓形成，且无主要出血并发症。
