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CASE REPORT

Surgical removal of thrombi in mechanical valvular prostheses

Pablo M. A PomerantzeffI; Wilson Luiz da SilveiraI; Jorge Y AfiuniI; Nana IkariI; Raquel SnitkowskyI; Max GrinbergI; Munir EbaidI; Miguel Barbero-MarcialI; Geraldo VerginelliI; A. D JateneI

DOI: 10.1590/S0102-76381993000100006

ABSTRACT

We report the surgical procedure which was adopted in two patients exhibiting thrombosis of mechanical prosthesis, a rare procedure and unprecedent in our Institution. A 19 years old male patient with a history of rheumatic fever in childhood, who had been submitted to two mitro-aortic substitutions, two metalic prostheses, having been introduced in the last surgery, which occurred in 1988. The patient, having of his own free will discontinued taking the anticoagulant, was admitted into the Emergency Department whith a condition of acute pulmonary oedema, with a diagnosis of thrombosis of the prosthesis. He was directed to the Surgical Centre where surgical depletion of the prosthesis was opted for, thus reducing the period of extracorporeal circulation of the patient in an extemely critical condition. Another patient, a two and a half years old female with a diagnosis of mitral insufficiency resulting from mixomatous degeneration, underwent mitral valve substitution for a mechanical prosthesis, on October 13, 1992. Despite satisfactory anticoagulation, the patient exhibited thrombosis of the prosthesis on January 12, 1993, and was also submitted to surgical thrombectomy. Both patients presented satisfactory pastoperative evolution. Three months following the thrombectomy, the second above mentioned patient exhibited a further acute thrombosis, which was followed by sucessful streptokinase. Surgical thrombectomy could be a satisfactory surgical option in high risk surgical patients exhibiting thrombi in metal prosthesis.

RESUMO

É relatada a retirada cirúrgica de trombos em próteses mecânicas em dois pacientes, manobra rara e inédita em nossa Instituição. O primeiro paciente, do sexo masculino, de 19 anos de idade, com história de doença reumática na infância, tendo sido submetido a duas duplas trocas mitro-aórticas, com duas próteses metálicas na última operação, realizada em 1988. Tendo descontinuado o uso de anticoagulantes por conta própria, deu entrada no pronto-socorro em edema agudo dos pulmões, com diagnóstico de trombose nas próteses. Foi levado ao centro cirúrgico, optando-se pela limpeza cirúrgica das próteses, diminuindo, desta forma, o tempo de circulação extracorpórea em paciente de extrema gravidade. Outra paciente, de 2 anos e 6 meses de idade, com diagnóstico de insuficiência mitral por degeneração mixomatosa, foi submetida a troca da valva mitral por prótese mecânica em 13/10/92. Apesar de bem anticoagulada, apresentou trombose da prótese e, no dia 12/1/93, foi submetida a trombectomia cirúrgica. Os dois pacientes apresentaram boa evolução pós-operatória, sendo que a segunda paciente, 3 meses após a trombectomia, apresentou nova trombose aguda, sendo administrada estreptoquinase, com sucesso. A trombectomia cirúrgica pode ser uma boa opção em pacientes com alto risco e portadores de trombose de próteses metálicas.
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Article receive on Sunday, March 28, 1993

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