medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2026.2.5medjournal-418Research ArticleОБЗОРЫREVIEWSТромбоз механических протезов клапанов сердца в клинической практикеMechanical prosthetic heart valve thrombosis in clinical practiceБорисА. М.BorysА. М.

Минск

Minsk

СавченкоМ. А.SavchenkoМ. А.

Минск

Minsk

АсташонокТ. В.AstashonakТ. V.

Минск

Minsk

СавченкоА. В.SavchenkoА. V.

Минск

Minsk

СубботаИ. В.SubbotaI. V.

Минск

Minsk

УО «Белорусский государственный медицинский университет»Belarusian State Medical UniversityГУ «Минский научно-практический центр хирургии, трансплантологии и гематологии»Minsk Scientific and Practical Center for Surgery, Transplantology and HematologyГУ «Минский научно-практический центр хирургии, трансплантологии и гематологии»Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology20262305202602515Copyright © Борис А.М., Савченко М.А., Асташонок Т.В., Савченко А.В., Суббота И.В., 20262026Борис А.М., Савченко М.А., Асташонок Т.В., Савченко А.В., Суббота И.В.Borys А.М., Savchenko М.А., Astashonak Т.V., Savchenko А.V., Subbota I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/418

Хирургическое протезирование клапанов по-прежнему остается одним из основных методов лечения пациентов с тяжелыми клапанными пороками сердца. Тромбоз механических протезов клапанов сердца является самой частой причиной их дисфункции и относится к жизнеугрожающим состояниям. Риск этого осложнения зависит от типа протеза, адекватности проводимой антикоагулянтной терапии, позиции клапана и наличия протромботических состояний. Неадекватная антикоагулянтная терапия с субтерапевтическим уровнем международного нормализованного отношения является наиболее важным фактором риска образования тромбов на протезированных клапанах. В статье описаны клинические признаки обструктивного и необструктивного тромбоза клапанов, а также современные методы его диагностики. Показано, что применение современных визуализирующих методов исследования имеет важное клиническое значение для определения этиологии дисфункции протезированного клапана, проведения дифференциальной диагностики между тромбом и паннусоми, а также для выбора дальнейшей лечебной тактики. Основными методами диагностики тромбоза протезированного клапана являются трансторакальная и чреспищеводная эхокардиография. При их недостаточной информативности применяют мультидетекторную компьютерную томографию. В настоящее время оптимизация антикоагулянтной терапии, тромболизис и хирургическое вмешательство являются основными методами лечения пациентов с данной патологией. Отмечено, что рандомизированных проспективных исследований, сравнивающих эффективность и безопасность хирургического лечения и тромболитической терапии при тромбозе механических протезов клапанов, недостаточно. Однако имеются доказательства, что применение низкодозовой медленной или сверхмедленной внутривенной инфузии тканевого активатора плазминогена под контролем чреспищеводной эхокардиографии приводит к высокой эффективности тромболизиса с низким уровнем осложнений и летальности.

Surgery plays a central role in the management of acquired valvular heart disease. Prosthetic valve thrombosis is a rare but serious life-threatening complication of valve replacement, most often encountered with mechanical prostheses. The risk of valve thrombosis depends on the type of prosthesis, the adequacy of anticoagulant therapy, the position of the valve and the presenceof prothrombotic conditions. Inadequate level of anticoagulation is the most important factor involved in the pathogenesis of prosthetic valve thrombosis. The severity of symptoms highly depends on the degree of valve obstruction caused by the prosthetic valve thrombosis. Multimodality imaging is crucial in the diagnosis and management of prosthetic heart valve thrombosis and also for differential diagnosis between thrombus and pannus. Optimization of anticoagulant therapy, thrombolysis and surgical intervention are the main methods of treatment of patients with valve thrombosis. Thrombolytic therapy has become an alternative to surgery in the treatment of obstructive prosthetic valve thrombosis in recent years. The use of low-dose slow or ultraslow intravenous infusion of tissue plasminogen activator under the control of transesophageal echocardiography leads to high efficiency of thrombolysis with a low level of complications and mortality. The efficacy and safety of thrombolysis compared to surgery should be confirmed with the results of large observational and randomized trials.

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The authors declare that there are no conflicts of interest present.