Mustapha R, Philip I, Bohm G, Depoix J P, Enguerand D, Debauchez M, Hvass U, Pansard Y, Desmonts J M, Langlois J
Service d'Anesthésie-Réanimation, Hôpital Bichat, Paris.
Ann Cardiol Angeiol (Paris). 1994 Sep;43(7):403-7.
Forty one patients were admitted with a diagnosis of prosthetic valve thrombosis. One patient was thrombolyzed successfully, and 40 underwent surgical procedures. In 13 cases, prosthetic valve thrombosis occurred in the first month after valve replacement. 18 patients were in functional class IV of the NYHA classification. Among the thrombosed prostheses, 91% were mechanical, and 61% in mitral position. Adequacy of anticoagulation was the most important risk factor, as this treatment was inappropriate in 20 patients. In 10 other patients, it had been changed for medical (bleeding events, pregnancy) or surgical (non cardiac surgery) reasons. The perioperative mortality rate was high (32.4%). It was 12% in patients in functional class II and 46% in those in class IV (p < 0.05). This underlines the value of early diagnosis, in which echocardiography, especially with a transesophageal probe, takes a major place, allowing prompt surgical treatment.
41例患者因人工瓣膜血栓形成入院。1例患者溶栓成功，40例接受了外科手术。13例人工瓣膜血栓形成发生在瓣膜置换后的第一个月。18例患者属于纽约心脏协会（NYHA）心功能分级IV级。在发生血栓的人工瓣膜中，91%为机械瓣膜，61%位于二尖瓣位置。抗凝治疗不足是最重要的危险因素，20例患者的抗凝治疗不恰当。另外10例患者因内科（出血事件、妊娠）或外科（非心脏手术）原因更改了治疗方案。围手术期死亡率很高（32.4%）。心功能II级患者的死亡率为12%，IV级患者为46%（p<0.05）。这凸显了早期诊断的价值，其中超声心动图，尤其是经食管探头超声心动图在早期诊断中占主要地位，能够实现及时的手术治疗。
