RESUMO
We present the case of a 40 year old woman, who had an aortic prosthetic valve, of the Björk Shiley type. Three months before admission she began with progressive dyspnea. She was admitted to the Cardiovascular Care Unit with a global cardiac failure. An aortic prosthetic valve thrombosis was diagnosed clinically (absence of the prosthetic click) and by radioscopy (a decrease in the movement of the valve disk, with an incomplete shunt). It was attributed to a secondary failure of the anticoagulant treatment. Despite the treatment she quickly developed a cardiogenic shock. A treatment with 750,000 UI of streptokinase in 30 min was started, followed by 100,000 UI during 12 hours, with total reversion of the hemodynamic features, as judged by clinical examination (recurrence of the prosthetic click), radioscopy (recurrence of the valve movement) and by Doppler echocardiography (reduction of the transvalvular gradient). No complications were observed, and in a follow up of 12 months she persisted asymptomatic. The prosthetic valve thrombosis is an infrequent and almost fatal complication. The classical therapy consists in surgery which is a procedure with a high mortality in patients with severe cardiac failure, and an emergency procedure, as it occurred in our patient. Despite the known success of the thrombolytic therapy in the prosthetic valve thrombosis of the right heart (tricuspid position) it was only in the last years that this treatment was reported in aortic or mitral position. Peripheric embolies were found in 13% of the cases, always with transitory symptoms. There are only 45 cases described in the world, and more experience is needed for definitive conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Cardiopatias/tratamento farmacológico , Próteses Valvulares Cardíacas/reabilitação , Terapia Trombolítica , Trombose/tratamento farmacológico , Adulto , Valva Aórtica , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Trombose/diagnóstico por imagem , Trombose/etiologia , UltrassonografiaRESUMO
Se presenta el caso de una paciente de sexo femenino, de 40 años de edad, portadora de una prótesis valvular tipo Bj÷rk Shiley en posición aórtica quien sufrió como complicación la trombosis de la misma, con progesivo deterioro hemodinámico, hasta llegar al schock cardidogénico. Se administró tratamiento trombolítico, con reversión total del cuadro. La conducta terapéutica tradicional es la quirúrgica, con elevado índice de mortalidad perioperatoria. Si bien el tratamiento trombolítico en trombosis de prótesis valvulares en posición tricuspídea fue sugerido desde 1971, hay pocos casos relatados de su aplicación a nivel de prótesis de cavidades izquierdas. Precisamente el motivo de este trabajo es la presentación de un caso, con la revisión de la literatura y el análisis de los beneficios potenciales de esta terapéutica (AU)
Assuntos
Humanos , Adulto , Feminino , Trombose/tratamento farmacológico , Terapia Trombolítica , Próteses Valvulares Cardíacas/efeitos adversos , Cardiopatias/tratamento farmacológico , Valva Aórtica , Trombose/diagnóstico por imagem , Trombose/etiologia , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologiaRESUMO
We present the case of a 40 year old woman, who had an aortic prosthetic valve, of the Bj÷rk Shiley type. Three months before admission she began with progressive dyspnea. She was admitted to the Cardiovascular Care Unit with a global cardiac failure. An aortic prosthetic valve thrombosis was diagnosed clinically (absence of the prosthetic click) and by radioscopy (a decrease in the movement of the valve disk, with an incomplete shunt). It was attributed to a secondary failure of the anticoagulant treatment. Despite the treatment she quickly developed a cardiogenic shock. A treatment with 750,000 UI of streptokinase in 30 min was started, followed by 100,000 UI during 12 hours, with total reversion of the hemodynamic features, as judged by clinical examination (recurrence of the prosthetic click), radioscopy (recurrence of the valve movement) and by Doppler echocardiography (reduction of the transvalvular gradient). No complications were observed, and in a follow up of 12 months she persisted asymptomatic. The prosthetic valve thrombosis is an infrequent and almost fatal complication. The classical therapy consists in surgery which is a procedure with a high mortality in patients with severe cardiac failure, and an emergency procedure, as it occurred in our patient. Despite the known success of the thrombolytic therapy in the prosthetic valve thrombosis of the right heart (tricuspid position) it was only in the last years that this treatment was reported in aortic or mitral position. Peripheric embolies were found in 13
of the cases, always with transitory symptoms. There are only 45 cases described in the world, and more experience is needed for definitive conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)
RESUMO
Se presenta el caso de una paciente de sexo femenino, de 40 años de edad, portadora de una prótesis valvular tipo Björk Shiley en posición aórtica quien sufrió como complicación la trombosis de la misma, con progesivo deterioro hemodinámico, hasta llegar al schock cardidogénico. Se administró tratamiento trombolítico, con reversión total del cuadro. La conducta terapéutica tradicional es la quirúrgica, con elevado índice de mortalidad perioperatoria. Si bien el tratamiento trombolítico en trombosis de prótesis valvulares en posición tricuspídea fue sugerido desde 1971, hay pocos casos relatados de su aplicación a nivel de prótesis de cavidades izquierdas. Precisamente el motivo de este trabajo es la presentación de un caso, con la revisión de la literatura y el análisis de los beneficios potenciales de esta terapéutica