Péterffy A, Henze A, Savidge G F, Landou C, Björk V O
Scand J Thorac Cardiovasc Surg. 1980;14(1):33-41. doi: 10.3109/14017438009109852.
Among 52 consecutive patients surviving tricuspid valve replacement with the Björk-Shiley tilting disc valve, follow-up extends between 1/2-9 years, mean 4.9 years. Four patients suffered thrombotic obstruction of their tricuspid prosthesis on 8 occasions, an incidence of 3.2%/year. Ebstein's anomaly and deficient anticoagulation were identified as likely contributory factors, but the complication remained unexplained in 2/8 instances. Thrombotic malfunction of the tricuspid prosthesis seems to constitute a relatively benign clinical entity with mild manifestations and diagnostic possibilities by non-invasive methods. Relief by means of thrombolytic treatment in the form of streptokinase (Kabikinase) (4) or replacement of the clotted prosthesis (4) involved neither disabling complications nor mortality. Our clinical observations and experimental studies suggest that thrombolytic therapy is effective, provided that prosthetic malfunction is due to a recent red clot, whereas encapsulation of the prosthetic disc by organized white-grey pannus necessitates re-operation. Streptokinase treatment should be attempted before surgery, but it is hardly meaningful to proceed for more than 24 hours. Restored prosthetic function within this time limit indicates the likely resolution of a red clot.
在连续52例接受Björk-Shiley倾斜盘式瓣膜三尖瓣置换术的存活患者中，随访时间为半年至9年，平均4.9年。4例患者的三尖瓣人工瓣膜发生8次血栓阻塞，发生率为每年3.2%。埃布斯坦畸形和抗凝不足被确定为可能的促成因素，但在8例中有2例并发症原因不明。三尖瓣人工瓣膜的血栓形成故障似乎是一种相对良性的临床情况，表现轻微，可用非侵入性方法诊断。采用链激酶（卡比激酶）进行溶栓治疗（4例）或更换血栓形成的人工瓣膜（4例），均未出现致残性并发症或死亡。我们的临床观察和实验研究表明，溶栓治疗是有效的，前提是人工瓣膜故障是由近期的红色血栓引起的，而人工瓣膜盘被有组织的灰白色血管翳包裹则需要再次手术。手术前应尝试链激酶治疗，但超过24小时进行治疗几乎没有意义。在此时间限制内恢复人工瓣膜功能表明红色血栓可能溶解。
