JACC. Case reports · 2025
Ultraslow Thrombolysis of Mechanical Tricuspid Prosthetic Thrombosis.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Afzal Uzma, Lau Jeffery, Yap Jonathan, Fam Jiang Ming, Ooi Inn Jia, Anbalakan Kamalesh, Tan Ju Le, Ding Zee Pin, Ewe See Hooi, Ho Kay Woon
Аннотация
BACKGROUND: Prosthetic heart valve implantation over the past 7 decades has revolutionized treatment of valvular heart disease. Mechanical heart valves, although more durable than a bioprosthesis, require lifelong anticoagulation, with risk of valve thrombosis-a serious, life-threatening complication with high morbidity and mortality.
CASE SUMMARY: We present a case of prosthetic mechanical tricuspid valve thrombosis that was successfully treated with thrombolysis using tissue plasminogen activator.
DISCUSSION: The incidence of prosthetic mechanical valve thrombosis ranges from 0.1% to 5.7% per year, with higher rates observed in the post-surgical period and for prosthetic tricuspid valves (20%) compared with aortic or mitral valves (0.5%-0.8%). American College of Cardiology /American Heart Association (AHA) 2020 guidelines recommend higher international normalized ratio (INR) for prosthetic tricuspid valve replacement (TVR) and mitral valve replacement 3.0 (INR: 2.5-3.5), as opposed to prosthetic aortic valve replacement 2.5 (INR: 2-3). Current guidelines recommend parenteral anticoagulation, thrombolysis, and redo valve replacement as treatment options for mechanical heart valve thrombosis. Thrombolytic treatment provides a suitable and effective alternative to surgery, with challenges in effective dose administration for right-sided prosthetic valves.
TAKE-HOME MESSAGE: An ultraslow thrombolysis regimen can provide a suitable and effective alternative to surgery in treatment of right-sided mechanical valve thrombosis.
CASE SUMMARY: We present a case of prosthetic mechanical tricuspid valve thrombosis that was successfully treated with thrombolysis using tissue plasminogen activator.
DISCUSSION: The incidence of prosthetic mechanical valve thrombosis ranges from 0.1% to 5.7% per year, with higher rates observed in the post-surgical period and for prosthetic tricuspid valves (20%) compared with aortic or mitral valves (0.5%-0.8%). American College of Cardiology /American Heart Association (AHA) 2020 guidelines recommend higher international normalized ratio (INR) for prosthetic tricuspid valve replacement (TVR) and mitral valve replacement 3.0 (INR: 2.5-3.5), as opposed to prosthetic aortic valve replacement 2.5 (INR: 2-3). Current guidelines recommend parenteral anticoagulation, thrombolysis, and redo valve replacement as treatment options for mechanical heart valve thrombosis. Thrombolytic treatment provides a suitable and effective alternative to surgery, with challenges in effective dose administration for right-sided prosthetic valves.
TAKE-HOME MESSAGE: An ultraslow thrombolysis regimen can provide a suitable and effective alternative to surgery in treatment of right-sided mechanical valve thrombosis.