. "Neobvykl\u00FD p\u0159\u00EDpad tromb\u00F3zy po n\u00E1hrad\u011B aort\u00E1ln\u00ED chlopn\u011B bioprot\u00E9zou" . "N" . "Neobvykl\u00FD p\u0159\u00EDpad tromb\u00F3zy po n\u00E1hrad\u011B aort\u00E1ln\u00ED chlopn\u011B bioprot\u00E9zou"@cs . "Matou\u0161kov\u00E1, Jana" . "6" . "An anusual case of thrombosis after the replacement of the aortic valve with a bioprosthesis"@en . . "RIV/00023884:_____/07:#0002199" . "5-6" . . . . . "5"^^ . . . "436862" . "[B94A390196E6]" . "An anusual case of thrombosis after the replacement of the aortic valve with a bioprosthesis"@en . "CZ - \u010Cesk\u00E1 republika" . "T\u00E1borsk\u00FD, Milo\u0161" . "5"^^ . . . "5"^^ . "Niederle, Petr" . "1213-807X" . . "Zemanov\u00E1, Iva" . "Neobvykl\u00FD p\u0159\u00EDpad tromb\u00F3zy po n\u00E1hrad\u011B aort\u00E1ln\u00ED chlopn\u011B bioprot\u00E9zou" . . . "Interven\u010Dn\u00ED a akutn\u00ED kardiologie" . . "Neobvykl\u00FD p\u0159\u00EDpad tromb\u00F3zy po n\u00E1hrad\u011B aort\u00E1ln\u00ED chlopn\u011B bioprot\u00E9zou"@cs . "Uv\u00E1d\u00EDme kazuistiku 69 let\u00E9 \u017Eeny, kter\u00E1 zem\u0159ela necel\u00E9 dva m\u011Bs\u00EDce po n\u00E1hrad\u011B aort\u00E1ln\u00ED chlopn\u011B bioprot\u00E9zou na srde\u010Dn\u00ED selh\u00E1n\u00ED v d\u016Fsledku rychl\u00E9 progrese aort\u00E1ln\u00ED sten\u00F3zy p\u0159i tromb\u00F3ze v oblasti bioprot\u00E9zy. Je diskutov\u00E1na problematika bioprot\u00E9z, zejm\u00E9na pak zaji\u0161\u0165uj\u00EDc\u00ED protisr\u00E1\u017Eliv\u00E1 l\u00E9\u010Dba v poopera\u010Dn\u00EDm obdob\u00ED a terapeutick\u00E9 mo\u017Enosti p\u0159i vzniku tromb\u00F3zy. Bioprot\u00E9za v aort\u00E1ln\u00ED pozici m\u00E1 obvykle u nerizikov\u00FDch pacient\u016F ( tj. kte\u0159\u00ED nemaj\u00ED p\u0159edchoz\u00ED tromboembolizaci v anamn\u00E9ze, hyperkoagula\u010Dn\u00ED stav, fibrilaci s\u00EDn\u00ED, n\u00E1lez tromb\u016F v dutin\u00E1ch srde\u010Dn\u00EDch, velikost lev\u00E9 s\u00EDn\u011B > 55 mm, dysfunkci lev\u00E9 komory srde\u010Dn\u00ED s EF < 30) nejmen\u0161\u00ED trombogenn\u00ED potenci\u00E1l ze v\u0161ech chlopenn\u00EDch n\u00E1hrad. Bioprot\u00E9zy obecn\u011B nevy\u017Eaduj\u00ED dlouhodobou antikoagula\u010Dn\u00ED l\u00E9\u010Dbu, posta\u010Duje pod\u00E1v\u00E1n\u00ED kyseliny acetylsalicylov\u00E9, nen\u00ED v\u0161ak jednotn\u00FD n\u00E1zor na nutnost antikoagulace prvn\u00ED t\u0159i m\u011Bs\u00EDce po implantaci. V\u00FDskyt tromb\u00F3zy bioprot\u00E9zy v aort\u00E1ln\u00ED pozici je vz\u00E1cn\u00FD, i na na\u0161em pracovi\u0161ti jde o prvn\u00ED p\u0159\u00EDpad. Jde o velmi z\u00E1va\u017Enou komplikaci, kter\u00E1 vede ke sten\u00F3ze chlopn\u011B, n\u011Bkdy spolu s jej\u00ED nedomykavost\u00ED. Klinick\u00E9 projevy z\u00E1vis\u00ED na rychlosti vzniku tromb\u00F3zy p\u0159i pomalu rostouc\u00EDm trombu zvolna progreduje du\u0161nost a nev\u00FDkonnost, akutn\u011B vznikl\u00E1 tromb\u00F3za vede rychle k t\u011B\u017Ek\u00E9 du\u0161nosti, srde\u010Dn\u00EDmu selh\u00E1n\u00ED a n\u00E1hl\u00E9 smrti. V diagnostice m\u00E1 hlavn\u00ED \u00FAlohu echokardiografie. L\u00E9\u010Dba je bu\u010F chirurgick\u00E1 reoperace chlopn\u011B, nebo syst\u00E9mov\u00E9 pod\u00E1n\u00ED trombol\u00FDzy. Zd\u016Frazn\u011Bna je nutnost pe\u010Dliv\u00E9ho zv\u00E1\u017Een\u00ED rizika tromboembolie u ka\u017Ed\u00E9ho pacienta a z toho vypl\u00FDvaj\u00EDc\u00ED protisr\u00E1\u017Eliv\u00E1 l\u00E9\u010Dba v poopera\u010Dn\u00EDm obdob\u00ED, d\u00E1le nutnost pravideln\u00FDch kontrol a sledov\u00E1n\u00ED stavu nemocn\u00E9ho k podchycen\u00ED event. po\u010D\u00E1te\u010Dn\u00EDch p\u0159\u00EDznak\u016F tromb\u00F3zy. To je \u00FAkol jak kardiolog\u016F a kardiochirurg\u016F, tak i praktick\u00FDch l\u00E9ka\u0159\u016F."@cs . . . . "Uv\u00E1d\u00EDme kazuistiku 69 let\u00E9 \u017Eeny, kter\u00E1 zem\u0159ela necel\u00E9 dva m\u011Bs\u00EDce po n\u00E1hrad\u011B aort\u00E1ln\u00ED chlopn\u011B bioprot\u00E9zou na srde\u010Dn\u00ED selh\u00E1n\u00ED v d\u016Fsledku rychl\u00E9 progrese aort\u00E1ln\u00ED sten\u00F3zy p\u0159i tromb\u00F3ze v oblasti bioprot\u00E9zy. Je diskutov\u00E1na problematika bioprot\u00E9z, zejm\u00E9na pak zaji\u0161\u0165uj\u00EDc\u00ED protisr\u00E1\u017Eliv\u00E1 l\u00E9\u010Dba v poopera\u010Dn\u00EDm obdob\u00ED a terapeutick\u00E9 mo\u017Enosti p\u0159i vzniku tromb\u00F3zy. Bioprot\u00E9za v aort\u00E1ln\u00ED pozici m\u00E1 obvykle u nerizikov\u00FDch pacient\u016F ( tj. kte\u0159\u00ED nemaj\u00ED p\u0159edchoz\u00ED tromboembolizaci v anamn\u00E9ze, hyperkoagula\u010Dn\u00ED stav, fibrilaci s\u00EDn\u00ED, n\u00E1lez tromb\u016F v dutin\u00E1ch srde\u010Dn\u00EDch, velikost lev\u00E9 s\u00EDn\u011B > 55 mm, dysfunkci lev\u00E9 komory srde\u010Dn\u00ED s EF < 30) nejmen\u0161\u00ED trombogenn\u00ED potenci\u00E1l ze v\u0161ech chlopenn\u00EDch n\u00E1hrad. Bioprot\u00E9zy obecn\u011B nevy\u017Eaduj\u00ED dlouhodobou antikoagula\u010Dn\u00ED l\u00E9\u010Dbu, posta\u010Duje pod\u00E1v\u00E1n\u00ED kyseliny acetylsalicylov\u00E9, nen\u00ED v\u0161ak jednotn\u00FD n\u00E1zor na nutnost antikoagulace prvn\u00ED t\u0159i m\u011Bs\u00EDce po implantaci. V\u00FDskyt tromb\u00F3zy bioprot\u00E9zy v aort\u00E1ln\u00ED pozici je vz\u00E1cn\u00FD, i na na\u0161em pracovi\u0161ti jde o prvn\u00ED p\u0159\u00EDpad. Jde o velmi z\u00E1va\u017Enou komplikaci, kter\u00E1 vede ke sten\u00F3ze chlopn\u011B, n\u011Bkdy spolu s jej\u00ED nedomykavost\u00ED. Klinick\u00E9 projevy z\u00E1vis\u00ED na rychlosti vzniku tromb\u00F3zy p\u0159i pomalu rostouc\u00EDm trombu zvolna progreduje du\u0161nost a nev\u00FDkonnost, akutn\u011B vznikl\u00E1 tromb\u00F3za vede rychle k t\u011B\u017Ek\u00E9 du\u0161nosti, srde\u010Dn\u00EDmu selh\u00E1n\u00ED a n\u00E1hl\u00E9 smrti. V diagnostice m\u00E1 hlavn\u00ED \u00FAlohu echokardiografie. L\u00E9\u010Dba je bu\u010F chirurgick\u00E1 reoperace chlopn\u011B, nebo syst\u00E9mov\u00E9 pod\u00E1n\u00ED trombol\u00FDzy. Zd\u016Frazn\u011Bna je nutnost pe\u010Dliv\u00E9ho zv\u00E1\u017Een\u00ED rizika tromboembolie u ka\u017Ed\u00E9ho pacienta a z toho vypl\u00FDvaj\u00EDc\u00ED protisr\u00E1\u017Eliv\u00E1 l\u00E9\u010Dba v poopera\u010Dn\u00EDm obdob\u00ED, d\u00E1le nutnost pravideln\u00FDch kontrol a sledov\u00E1n\u00ED stavu nemocn\u00E9ho k podchycen\u00ED event. po\u010D\u00E1te\u010Dn\u00EDch p\u0159\u00EDznak\u016F tromb\u00F3zy. To je \u00FAkol jak kardiolog\u016F a kardiochirurg\u016F, tak i praktick\u00FDch l\u00E9ka\u0159\u016F." . "RIV/00023884:_____/07:#0002199!RIV12-MZ0-00023884" . . "This is the case of a 69 year old woman who died less than two months after replacement of the aortic valve with a bioprosthesis of heart failure as a result of the rapid progression of aortic stenosis from a thrombotic obstruction in the region of the bioprosthesis. We discuss the problems involved with the use of bioprostheses, particularly whether anti-coagulants should be administered during the post-operative period and the therapeutic options in the event of thrombosis. Generally, in low-risk patients, (meaning those who have no prior history of thrombo-embolization, hypercoagulation, atrial fibrillation, findings of thrombi in the heart cavities, with a left atrium > 55 mm, no dysfunction of the left ventricle with an EF < 30%) aortic bioprostheses have the lowest thrombogenic potential of all valve replacements. Normally bioprostheses do not require long-term anti-coagulation therapy and the administration of acetyl-salicylic acid is generally sufficient, however there is no single opinion on the need for anti-coagulants during the first three months after the implant. The occurrence of thrombosis of an aortic bioprosthesic valve is extremely rare and this is the first ever case in our centre. It is a very serious complication, leading to stenosis of the valve, sometimes accompanied by its insufficiency. The clinical signs depend on the speed with which the thrombosis occurs when the thrombus grows slowly the patient experiences progressive breathing difficulties and listlessness, while acute thrombosis quickly leads to severe lack of breath, heart failure and sudden death. The main diagnostic tool is the echocardiogram. Treatment is either surgical reoperation of the valve, or systemic thrombolytic therapy. We must emphasize the need to carefully evaluate the risk of thrombo-embolism in each patient and the need for anti-coagulation treatment in the post-operative period will be based on thi"@en . "valve prosthesis, aortal bioprosthesis, thrombosis"@en . "Bene\u0161ov\u00E1, Miroslava" .