• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>European Heart Journal - Case Reports >Case report of successful low-dose, ultra-slow infusion thrombolysis of prosthetic mitral valve thrombosis in a high risk patient after redo-mitral valve replacement
【24h】

Case report of successful low-dose, ultra-slow infusion thrombolysis of prosthetic mitral valve thrombosis in a high risk patient after redo-mitral valve replacement

机译：成功低剂量，超缓慢输注溶栓的案例报告在重做瓣膜置换后高危患者中假体二尖瓣血栓形成的

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background An increase in transvalvular pressure gradient of prosthetic valve should always raise suspicion for obstructive valve thrombosis. A multimodality diagnostic approach including transthoracic echocardiography, transoesophageal echocardiography (TOE), cinefluoroscopy, or computed tomography (CT) is necessary for a prompt diagnosis. The management of mechanical prosthetic valve thrombosis (PVT) is high risk in any therapeutic option taken. Emergency valve replacement is recommended for critically ill patients. Fibrinolysis is an alternative for patients with contraindication to surgery or if surgery is not immediately available. Case summary A 52-year-old woman presented with symptoms and signs of cardiac congestion. On laboratory, brain natriuretic peptide was elevated and international normalized ratio (INR) was in subtherapeutic range. She underwent a mitral valve replacement with mechanical prosthesis 7?months before, because of a significant residual regurgitation after repair on the same year. TOE revealed severe stenosis of the prosthesis with immobile anterior disc but there was no mass present. CT revealed a minor lesion at the hinge points of the prosthesis without involvement of the ring, suggestive for thrombus. The initial fruitless management with intravenous (i.v) heparin in high therapeutic range was followed by a successful ‘low-dose, ultra-slow’ fibrinolysis. Discussion CT may help differentiate thrombus vs. pannus. The acute onset of symptoms, inadequate anticoagulation, and restricted leaflet motion increased the suspicion for PVT. The current European guidelines propose normal dose fibrinolysis. We performed ‘low-dose, ultra-slow’ fibrinolysis due to lower bleeding risk with successful results. Low dose should be considered as alternative to normal dose fibrinolysis or urgent surgery.
机译：背景技术假体瓣膜的分瓣瓣膜梯度的增加应始终引起阻塞性瓣膜血栓形成的怀疑。需要进行Transtohoracic超声心动图，转基因超声心动图（TOE），Cinefluororarcopy或计算机断层扫描（CT）的多模诊断方法是及时诊断所必需的。机械假体瓣膜血栓形成（PVT）的管理是患有任何治疗选择的高风险。适用于批判性患者的应急阀门更换。纤维蛋白溶解是对手术禁忌症的患者的替代方案，或者如果手术没有立即可用。案例摘要A 52岁女性呈现出心血交的症状和迹象。在实验室，脑钠尿肽升高，国际标准化比（INR）在次规化范围内。由于同年修复后，她经历了二尖瓣置换术，以前有7个月？几个月，因为在同一年的修复后具有显着的剩余反流性。脚趾揭示了对固定前盘的假体的严重狭窄，但没有质量存在。 CT揭示了假体的铰链点的轻微病变而不涉及环，施动血栓。在高治疗范围内具有静脉内（I.V）肝素的初始无果律管理是成功的“低剂量，超慢”纤维蛋白溶解。讨论CT可能有助于区分血栓与豆类。症状的急性发作，抗凝和限制传单运动不足，增加了PVT的怀疑。目前欧洲指南提出正常剂量纤维蛋白溶解。由于具有成功结果，我们通过较低的出血风险进行了“低剂量，超慢”纤维蛋白溶解。低剂量应被视为正常剂量纤维蛋白溶解或紧急手术的替代品。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号