Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA.
Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
J Am Coll Cardiol. 2023 May 30;81(21):2115-2127. doi: 10.1016/j.jacc.2023.03.412.
Mechanical prosthetic heart valves, though more durable than bioprostheses, are more thrombogenic and require lifelong anticoagulation. Mechanical valve dysfunction can be caused by 4 main phenomena: 1) thrombosis; 2) fibrotic pannus ingrowth; 3) degeneration; and 4) endocarditis. Mechanical valve thrombosis (MVT) is a known complication with clinical presentation ranging from incidental imaging finding to cardiogenic shock. Thus, a high index of suspicion and expedited evaluation are essential. Multimodality imaging, including echocardiography, cine-fluoroscopy, and computed tomography, is commonly used to diagnose MVT and follow treatment response. Although surgery is oftentimes required for obstructive MVT, other guideline-recommended therapies include parenteral anticoagulation and thrombolysis. Transcatheter manipulation of stuck mechanical valve leaflet is another treatment option for those with contraindications to thrombolytic therapy or prohibitive surgical risk or as a bridge to surgery. The optimal strategy depends on degree of valve obstruction and the patient's comorbidities and hemodynamic status on presentation.
机械人工心脏瓣膜虽然比生物瓣更耐用，但更容易形成血栓，需要终身抗凝。机械瓣膜功能障碍可由以下 4 种主要现象引起：1）血栓形成；2）纤维性假性血管增生；3）变性；4）心内膜炎。机械瓣膜血栓形成（MVT）是一种已知的并发症，临床表现从偶然的影像学发现到心源性休克不等。因此，高度怀疑和加速评估是必不可少的。多模态成像，包括超声心动图、电影透视和计算机断层扫描，常用于诊断 MVT 并随访治疗反应。尽管对于阻塞性 MVT 通常需要手术，但其他指南推荐的治疗方法包括肠外抗凝和溶栓。对于溶栓治疗禁忌或手术风险过高的患者，或作为手术桥接的患者，经导管操作卡在机械瓣叶上是另一种治疗选择。最佳策略取决于瓣膜阻塞的程度以及患者的合并症和就诊时的血流动力学状态。
