Mahmut YESİN, Macit KALÇIK, Mehmet ÖZKAN, Mustafa Ozan GÜRSOY, Mustafa YILDIZ

Serial Fluoroscopy Guided Fibrinolytic Therapy in a Patient with Obstructive Mechanical Aortic Valve Thrombosis

Protez kapak trombozu genellikle yetersiz antikoagüle edilmiş hastalarda rastlanan hayatı tehdit edici bir komplikasyondur. Protez kapak trombozu tanısında 2-boyutlu ve gerçek zamanlı 3-boyutlu transözafajeal ekokardiyografi altın standart görüntüleme yöntemleri olmasına rağmen, bu yöntemlerle aort konumundaki protez kapaklar çok net değerlendirilemeyebilir. Bu durum protez aort kapak trombozu nedeniyle trombolitik tedavi alan hastaların takibinde önemli bir problem oluşturur. Floroskopi bu şekilde kapak hareketlerinde kısıtlılık olan hastaların takibinde kapak hareketleri hakkında değerli bilgiler sunan alternatif noninvaziv görüntüleme yöntemidir. Burada bir protez aort kapak trombozu tanılı olguda seri floroskopi kılavuzluğunda düşük doz (25 mg) doku plazminojen aktivatörünün çok yavaş infüzyonu (25 saat) ile yapılan trombolitik tedaviyi sunmaktayız.

Tıkayıcı Mekanik Aort Kapak Trombozu Olan Bir Hastanın Seri Floroskopi Kılavuzluğunda Pıhtı Eritici İlaç ile Tedavisi

Prosthetic valve thrombosis is a life-threatening complication, which is most commonly seen in patients with poor anticoagulation. Although two-dimensional and real-time three-dimensional transesophageal echocardiography are the gold standard imaging modalities for the diagnosis of prosthetic valve thrombosis, prosthetic valves in aortic position may not be evaluated precisely. This is a serious problem during the followup of the patients who receive thrombolytic therapy for aortic valve thrombosis. Fluoroscopy is an alternative noninvasive imaging method, which provides valuable information about leaflet motion and may be used for such cases with restricted leaflets. Here, we report a case of aortic valve thrombosis that was managed with low-dose (25 mg) and ultra-slow (25 hours) infusion of tissue-type plasminogen activator under the guidance of serial fluoroscopy.

PDF

___

Özkan M, Çakal B, Karakoyun S, Gürsoy OM, Çevik C, Kalçık M, et al. Thrombolytic therapy for the treatment of prosthetic heart valve thrombosis in pregnancy with low-dose, slow infusion of tissue-type plasminogen activator. Circulation 2013;128:532-40.
Özkan M, Gündüz S, Biteker M, Astarcioglu MA, Çevik C, Kaynak E, et al. Comparison of different TEE-guided thrombolytic regimens for prosthetic valve thrombosis: the TROIA trial. JACC Cardiovasc Imaging 2013;6:206-16.
Montorsi P, De Bernardi F, Muratori M, Cavoretto D, Pepi M. Role of cine-fluoroscopy, transthoracic, and transesophageal echocardiography in patients with suspected prosthetic heart valve thrombosis. Am J Cardiol 2000;85:58-64.
Licata A, Matthai WH Jr. Evaluating the etiology of mechanical valve obstruction: use of clinical parameters, fluoroscopy, and echocardiography. Catheter Cardiovasc Interv 2002;55:495-500.
Muratori M, Montorsi P, Maffessanti F, Teruzzi G, Zoghbi WA, Gripari P, et al. Dysfunction of bileaflet aortic prosthesis: accuracy of echocardiography versus fluoroscopy. JACC Cardiovasc Imaging 2013;6:196-205.
Montorsi P, Cavoretto D, Alimento M, Muratori M, Pepi M. Prosthetic mitral valve thrombosis: can fluoroscopy predict the efficacy of thrombolytic treatment? Circulation 2003;108(Suppl 1):II79-84.
Montorsi P, Cavoretto D, Ballerini G. Thrombosis of mechanical heart valve prostheses: revisiting the role of fluoroscopy. Br J Radiol 2000;73:76-9.
Cianciulli TF, Lax JA, Saccheri MC, Guidoin R, Salvado CM, Fernández AJ, et al. Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve. Eur J Echocardiogr 2008;9:65-8.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi