Trata-se de paciente feminina, 27 anos, com passado de trova valvar mitral por bioprótese há 7 anos, sem acompanhamento médico regular, evoluindo com palpitações e dispnéia progressiva aos esforços. Ecocardiograma revela prótese mitral gravemente degenerada com disfunção do tipo estenose, sobrecarga de pressão do ventrículo direito (HP grave) e...
Tem um átrio naquele trombo!!!!! Sim, aquilo ali é a cavidade atrial!!
Paciente (eco) foi submetida a trombólise química com rTPA.
Este foi o resultado após 24 horas da administração da droga
Recomendo a leitura deste artigo
1. All patients with suspected TPVs should undergo echocardiographic study. If adequate visualization of the prosthetic valve is not obtained by a transthoracic study, then a transesophageal echocardiographic study should be undertaken (level of evidence I).
2. Patients with right-sided TPVs should be treated with intravenous rtPA (100 mg administered as 10 mg immediate intravenous bolus followed by 90 mg infused over 90 min) or SK (500,000 IU over 20 min followed by 1.5 million IU infused over 10 h). Reduced doses should be employed in children and very small adults (level of evidence IIa).
3. Patients who are critically ill on presentation with TPV (pulmonary edema, hypotension, NYHA class III/IV symptoms) should receive immediate intravenous thrombolytic therapy as outlined earlier following appropriate echocardiographic confirmation of TPV (level of evidence IIa.
a. Serial echocardiographic studies should be performed in these individuals, and repeated infusions of thrombolytic therapy should be administered if complete resolution of prosthetic valve thrombus is not achieved (level of evidence IIa).
b. Concomitant intravenous unfractionated heparin should be administered along with thrombolytic therapy to achieve an activated partial thromboplastin time that is 1.5 to 2.0 times control (level of evidence IIb).
c. Cardiac surgical consultation should be sought urgently. Valve replacement should be seriously considered if repeated infusions of thrombolytic therapy fail to adequately dissolve the thrombus on the prosthetic valve (level of evidence IIa).
4. Patients with TPV who are clinically stable, that is, in NYHA clinical class I or II, may be managed medically with thrombolytic/antithrombotic therapy or surgically with valve replacement depending on physician/patient preference (level of evidence IIa).