Agrawal D, Dubey S, Saket B, Bhargava M, Mehta N, Lohchab S S, Satsangi D K, Nigam M, Gupta B K, Khanna S K
Department of Cardiothoracic Surgery and Cardiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1997 Jul-Aug;49(4):383-6.
In order to clarify the role of thrombolytic therapy for treatment of prosthetic valve thrombosis, all cases admitted in the intensive care unit (ICU), between March 1987 and March 1997 with the diagnosis of prosthetic valve thrombosis and treated with streptokinase, were analysed. In total, 42 patients with clinical and echocardiographic evidence of left side tilting disc prosthetic valve thrombosis were treated. All the patients had only mitral valve prosthesis involvement. Streptokinase was administered as a bolus of 2.5 lac units over 30 minutes followed by 1 lac units/hour for 48-72 hours. Thirty-seven (88%) patients had successful thrombolysis. Overall mortality occurred in 9.5 percent patients due to systemic embolism and bleeding complications. Serial clinical, radiological and echocardiographic studies showed successful thrombolysis in 88 percent patients. This study demonstrates that streptokinase therapy is safe and effective first line treatment for left-sided prosthetic valve thrombosis and surgery should be reserved for those patients who fail to respond to thrombolytic therapy.
为了阐明溶栓治疗在人工瓣膜血栓形成治疗中的作用，我们分析了1987年3月至1997年3月间入住重症监护病房（ICU）、诊断为人工瓣膜血栓形成并接受链激酶治疗的所有病例。共有42例有临床及超声心动图证据证实左侧倾斜碟瓣人工瓣膜血栓形成的患者接受了治疗。所有患者仅二尖瓣人工瓣膜受累。链激酶以25万单位的剂量在30分钟内静脉推注，随后以1万单位/小时的速度持续输注48 - 72小时。37例（88%）患者溶栓成功。总体死亡率为9.5%，主要是由于全身栓塞和出血并发症。系列临床、放射学及超声心动图研究显示88%的患者溶栓成功。本研究表明，链激酶治疗是左侧人工瓣膜血栓形成安全有效的一线治疗方法，对于溶栓治疗无效的患者应考虑手术治疗。
