Agozzino L, Bellitti R, Schettini S, Cotrufo M
Int J Cardiol. 1984 Mar;5(3):351-9. doi: 10.1016/0167-5273(84)90112-8.
We observed four cases of prosthetic thrombosis in 77 patients who had had a tilting disc valve (Sorin model) inserted in the mitral position. In all cases, the clinical findings on admission consisted of congestive heart failure, absence of prosthetic closing click and mitral regurgitation murmur. M-mode and cross-sectional echocardiography were invariably diagnostic. Surgery was performed without delay and consisted of thrombectomy in one case and valve replacement with porcine xenograft in three. Examination of the explanted prostheses disclosed fibrous tissue overgrowth surrounding the valvular ring, as well as thrombotic vegetations on the ventricular and atrial sides. The disc appeared blocked in a semiopening position at an angle of 45 degrees. Our experience suggests that the thrombosis is secondary to disc malfunction itself produced by periannular tissue growth. It is related to the porosity of the fabric which surrounds the metal ring, the valve design and its orientation. Correct anticoagulation therapy, performed in all cases, had no significant effect on tissue overgrowth. The high postoperative mortality rate depended on the severity of the preoperative clinical condition of the patients.
我们在77例二尖瓣位植入倾斜碟瓣（索林模型）的患者中观察到4例人工瓣膜血栓形成。所有病例入院时的临床表现均为充血性心力衰竭、人工瓣膜关闭喀喇音消失及二尖瓣反流杂音。M型和切面超声心动图始终具有诊断价值。均及时进行了手术，1例进行了血栓切除术，3例用猪异种移植物置换了瓣膜。对取出的人工瓣膜进行检查发现，瓣膜环周围有纤维组织过度生长，心室侧和心房侧有血栓性赘生物。碟片呈45度角的半开放位置受阻。我们的经验表明，血栓形成继发于瓣环周围组织生长导致的碟片本身功能障碍。它与围绕金属环的织物孔隙率、瓣膜设计及其取向有关。所有病例均进行了正确的抗凝治疗，但对组织过度生长无显著影响。术后高死亡率取决于患者术前临床状况的严重程度。
