PDF(Pubmed)
Abstract：
UNASSIGNED: The use of anticoagulation is mandatory for prevention of prosthetic valve thrombosis (PVT) worldwide, regardless of the valve type or position in the heart. In case a thrombosis causes symptomatic dysfunction, treatment usually includes the use of thrombolytic therapy or surgery. We report a case of PVT involving a patient with a mechanical aortic valve which was treated entirely with the use of anticoagulation therapy (warfarin).
UNASSIGNED: A 58-year-old man had an aortic valve replacement using a Carbomedics® mechanical valve due to severe aortic stenosis as a result of a calcific bicuspid native aortic valve. He was commenced on warfarin after surgery which was continued thereafter. He presented to our hospital after three years with shortness of breath at rest. On clinical examination, his condition was poor with a New York Heart Association functional classification of IV. He was in sinus rhythm and had an enlarged heart shadow on chest X-ray. Transesophageal echocardiography (TEE) revealed aortic valve regurgitation with vegetations on the anterior valve leaflet causing reduced hemi leaflet motility and a mean pressure gradient of 50 mmHg. Cinefluoroscopy revealed a dysfunctional mechanical valve leaflet. Surgery was at high risk of mortality due to the patient\'s clinical status and he was continued on warfarin therapy with close monitoring. Cinefluoroscopy and echocardiography done six months later revealed complete dissolution of thrombus and a normally functioning mechanical aortic valve.
UNASSIGNED: Only a few cases of symptomatic, thrombotic mechanical aortic valve were entirely treated with anticoagulation only. Our patient is one such case who had resolution of symptoms and improvement on NYHA functional classification (IV to I).
UNASSIGNED: A 58-year-old man had an aortic valve replacement using a Carbomedics® mechanical valve due to severe aortic stenosis as a result of a calcific bicuspid native aortic valve. He was commenced on warfarin after surgery which was continued thereafter. He presented to our hospital after three years with shortness of breath at rest. On clinical examination, his condition was poor with a New York Heart Association functional classification of IV. He was in sinus rhythm and had an enlarged heart shadow on chest X-ray. Transesophageal echocardiography (TEE) revealed aortic valve regurgitation with vegetations on the anterior valve leaflet causing reduced hemi leaflet motility and a mean pressure gradient of 50 mmHg. Cinefluoroscopy revealed a dysfunctional mechanical valve leaflet. Surgery was at high risk of mortality due to the patient\'s clinical status and he was continued on warfarin therapy with close monitoring. Cinefluoroscopy and echocardiography done six months later revealed complete dissolution of thrombus and a normally functioning mechanical aortic valve.
UNASSIGNED: Only a few cases of symptomatic, thrombotic mechanical aortic valve were entirely treated with anticoagulation only. Our patient is one such case who had resolution of symptoms and improvement on NYHA functional classification (IV to I).
摘要：
■在全球范围内，必须使用抗凝药物来预防人工瓣膜血栓形成（PVT），无论心脏中的瓣膜类型或位置。如果血栓形成导致症状功能障碍，治疗通常包括使用溶栓治疗或手术。我们报告了一例PVT，涉及一名机械主动脉瓣患者，该患者完全使用抗凝治疗（华法林）进行治疗。
■一名58岁男子因钙化的二叶天然主动脉瓣导致严重的主动脉瓣狭窄，使用Carbomedics®机械瓣膜进行了主动脉瓣置换术。他在手术后开始服用华法林，此后继续进行。三年后，他因休息时呼吸急促而来到我们医院。在临床检查中，根据纽约心脏协会IV的功能分类，他的病情较差。他处于窦性心律，胸部X光检查有扩大的心脏阴影。经食管超声心动图（TEE）显示主动脉瓣反流，前瓣膜小叶上有植被，导致半小叶运动减少，平均压力梯度为50mmHg。X线透视检查显示机械瓣膜小叶功能失调。由于患者的临床状态，手术死亡的风险很高，患者继续接受华法林治疗并密切监测。六个月后进行的透视和超声心动图检查显示血栓完全溶解，机械性主动脉瓣正常。
■只有少数有症状的病例，血栓性机械性主动脉瓣完全仅用抗凝治疗.我们的患者就是这样一个病例，其症状得到缓解，NYHA功能分类得到改善（IV至I）。
■一名58岁男子因钙化的二叶天然主动脉瓣导致严重的主动脉瓣狭窄，使用Carbomedics®机械瓣膜进行了主动脉瓣置换术。他在手术后开始服用华法林，此后继续进行。三年后，他因休息时呼吸急促而来到我们医院。在临床检查中，根据纽约心脏协会IV的功能分类，他的病情较差。他处于窦性心律，胸部X光检查有扩大的心脏阴影。经食管超声心动图（TEE）显示主动脉瓣反流，前瓣膜小叶上有植被，导致半小叶运动减少，平均压力梯度为50mmHg。X线透视检查显示机械瓣膜小叶功能失调。由于患者的临床状态，手术死亡的风险很高，患者继续接受华法林治疗并密切监测。六个月后进行的透视和超声心动图检查显示血栓完全溶解，机械性主动脉瓣正常。
■只有少数有症状的病例，血栓性机械性主动脉瓣完全仅用抗凝治疗.我们的患者就是这样一个病例，其症状得到缓解，NYHA功能分类得到改善（IV至I）。
