Conclusions
Recurrent valvular thrombosis is a significant morbid situation
affecting a group of patients with mechanical valve in tricuspid
position. Chronic thrombosis and the presence of pannus are associated
with a diminished thrombolysis success. Inadequate use of fibrinolytic
agents in terms of dose and time could result in an incomplete
disappearance of clot, thus enhance recurrent thrombosis. Although
fibrinolysis as the first step treatment and surgery in failed
thrombolytic therapy carry their own risks, anticoagulant
intensification alone in chronic valve obstruction is associated with
poor prognosis. The probability of significant bleeding such as
retroperitoneal hematoma and unusual cerebrovascular events following
right-sided thrombolysis in patients with potential sources of emboli
should be considered. A meticulous follow-up plan including oral
anticoagulant dose adjustment and state-of-the-art imaging evaluations
at presentation, early post-operative, and subsequent to thrombolysis is
of paramount importance in this setting.