Bonnefoy E, Perinetti M, Girard C, Robin J, Ninet J, Barthelet N, Lehot J J, Touboul P
Service de cardiologie, hôpital cardiovasculaire Louis-Pradel, Bron, BP Lyon-Montchat.
Arch Mal Coeur Vaiss. 1995 Mar;88(3):315-9.
Systematic transoesophageal echocardiography after the 10th day of mitral valve replacement with a mechanical prosthesis has enable diagnosis of several abnormal conditions: thrombi, strands and paravalvular leaks. The aim of this prospective study was to determine the prevalence of these conditions by biplane transoesophageal echocardiography in the first 24 postoperative hours. Transthoracic and transoesophageal echocardiography was performed on average 12 +/- 3 hours after coming out of the surgical block in 77 consecutive patients who underwent mitral valve replacement with a mechanical prosthesis. Nine patients (11.7%) had appearances of thrombi or strands in the left atrium or auricle. These small thrombi (1 to 1.5 cm2) were not obstructive. No embolic events were observed in the first month of these patients. Spontaneous contrast was seen in the left atrium of 31 patients (40%). The factors associated with the presence of thrombus or strands were advanced age (p = 0.02), presence of spontaneous contrast (p = 0.02) and more dilated left atrium (p = NS) Paraprosthetic leaks were seen in 11 cases (14.3%). In 10 cases, the regurgitant jets were narrow at their origin with little extension into the left atrium. Only one patient had severe regurgitation associated with raised transprosthetic pressure gradients. Cases with paravalvular leaks had a lower incidence of spontaneous contrast (3.2% vs 21.7%) and no thrombosis. Transoesophageal echocardiography demonstrated spontaneous contrast, thrombi and strands in the initial hours following implantation of a mechanical mitral valve prosthesis. The prevalence of these appearances, comparable to that of the results reported with later investigations, underlines the importance of effective anticoagulation from the fist postoperative hours.
在二尖瓣置换术后第10天使用机械瓣膜假体后进行系统性经食管超声心动图检查，已能诊断出几种异常情况：血栓、条索和瓣周漏。这项前瞻性研究的目的是通过双平面经食管超声心动图确定这些情况在术后最初24小时内的发生率。对77例连续接受二尖瓣置换并使用机械瓣膜假体的患者，在手术麻醉苏醒后平均12±3小时进行经胸和经食管超声心动图检查。9例患者（11.7%）在左心房或心耳出现血栓或条索表现。这些小血栓（1至1.5平方厘米）无阻塞性。在这些患者的第一个月未观察到栓塞事件。31例患者（40%）左心房可见自发显影。与血栓或条索存在相关的因素有高龄（p = 0.02）、存在自发显影（p = 0.02）和左心房更扩张（p = 无显著性差异）。11例（14.3%）可见瓣周漏。在10例中，反流束起始处狭窄，很少延伸至左心房。只有1例患者有严重反流并伴有跨瓣压差升高。有瓣周漏的病例自发显影发生率较低（3.2%对21.7%）且无血栓形成。经食管超声心动图显示在植入机械二尖瓣假体后的最初数小时内存在自发显影、血栓和条索。这些表现的发生率与后期研究报告的结果相当，强调了术后最初数小时有效抗凝的重要性。
