Consultant Interventional Cardiologist, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia.
General Practitioner, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia.
PLoS One. 2023 Apr 20;18(4):e0284652. doi: 10.1371/journal.pone.0284652. eCollection 2023.
Prosthetic Valve Thrombosis (PVT) is rare but life threatening condition which requires urgent intervention. Patient treatment outcome is not well studied in resource limited settings and the current study aims to explore the treatment outcome of patients with PVT at the Cardiac Center of Ethiopia.
The study was conducted at the Cardiac Center of Ethiopia which provides heart valve surgery. All patients who were diagnosed and managed for PVT in the center during the period July 2017 to March 2022 were included in the study. Data were collected through chart abstraction by using a structured questionnaire. Data analysis was done using SPSS version 20.0 for windows software.
Eleven patients (13 episodes of stuck valve) with PVT were included in the study and nine of them were female. The median age was 28 years old (IQR 22.5-34.0) with the youngest and oldest patients being 18 and 46 years old respectively. All the patients had bi-leaflet prosthetic mechanical valves (10 at mitral valve, two at aortic and mitral and one at aortic positions). The median duration of valve replacement before having PVT was 36 months (IQR 5-72). All patients reported good adherence to anticoagulant therapy; yet only five had optimal INR value. Nine patients presented with failure symptoms. Eleven patients received thrombolytic therapy and nine of them responded to it. One patient operated for failed thrombolytic therapy. Two patients responded to heparinization and optimization of anticoagulant therapy. Of the ten patients who received streptokinase, two of them developed fever and one patient developed bleeding as a complication of the treatment. All the patients survived hospital discharge.
Prosthetic valve thrombosis was accompanied by sub-optimal anticoagulant therapy. Most patients responded to medical therapy alone.
人工心脏瓣膜血栓形成（PVT）较为罕见，但可危及生命，需要紧急干预。在资源有限的环境下，患者的治疗结果尚未得到充分研究，本研究旨在探讨埃塞俄比亚心脏中心 PVT 患者的治疗结果。
本研究在提供心脏瓣膜手术的埃塞俄比亚心脏中心进行。所有在 2017 年 7 月至 2022 年 3 月期间在该中心被诊断并接受 PVT 治疗的患者均被纳入本研究。通过使用结构化问卷从病历中提取数据。数据分析使用 SPSS 版本 20.0 for windows 软件进行。
研究共纳入 11 例（13 例瓣叶粘连）PVT 患者，其中 9 例为女性。中位年龄为 28 岁（IQR 22.5-34.0），年龄最小和最大的患者分别为 18 岁和 46 岁。所有患者均使用双叶式人工机械瓣膜（10 例在二尖瓣，2 例在主动脉瓣和二尖瓣，1 例在主动脉瓣）。PVT 发生前的瓣膜置换中位时间为 36 个月（IQR 5-72）。所有患者均报告良好的抗凝治疗依从性；但仅有 5 例患者的 INR 值达到最佳。9 例患者出现心力衰竭症状。11 例患者接受溶栓治疗，其中 9 例有效。1 例患者因溶栓治疗失败而手术。2 例患者对肝素化和优化抗凝治疗有反应。在接受链激酶治疗的 10 例患者中，有 2 例出现发热，1 例出现出血并发症。所有患者均存活出院。
人工心脏瓣膜血栓形成常伴有抗凝治疗不充分。大多数患者仅通过药物治疗即可获得缓解。
