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.