Management of recurrent mechanical prosthetic tricuspid valve thrombosis in the perioperative period of noncardiac surgery: a case report

Amena Hussain,Tudor Vagaonescu

doi:10.1186/1752-1947-6-150

Amena Hussain, Tudor Vagaonescu

Open Access

https://doi.org/10.1186/1752-1947-6-150

Copy DOI

Abstract

IntroductionMechanical valves in the tricuspid position may be prone to thrombosis with even brief lapses in anticoagulation. The management of patients with a history of recurrent mechanical tricuspid valve thrombosis who require noncardiac surgery is complex.Case presentationA 43-year-old Pakistani woman with a mechanical tricuspid valve and a history of multiple episodes of mechanical valve thrombosis presented for noncardiac surgery. After her surgery she was found to have another episode of valve thrombosis and underwent a redo tricuspid valve replacement.ConclusionThis case brings up the important dilemma that exists when patients with a mechanical tricuspid valve and a history of recurrent valve thrombosis require noncardiac surgery.

Highlights

Mechanical valves in the tricuspid position may be prone to thrombosis with even brief lapses in anticoagulation
This case brings up the important dilemma that exists when patients with a mechanical tricuspid valve and a history of recurrent valve thrombosis require noncardiac surgery
Tricuspid valve (TV) replacement is not a common operation and low flows on the right side of the heart increase the risk of thrombosis

Summary

Introduction

Tricuspid valve (TV) replacement is not a common operation and low flows on the right side of the heart increase the risk of thrombosis. Case presentation A 43-year-old Pakistani woman presented for gynecologic surgery for an ovarian mass Seventeen years prior, she had an emergency TV replacement with a St Jude bileaflet tilting disc prosthetic valve for bacterial endocarditis of her TV. Anticoagulation with warfarin without an antiplatelet agent was maintained and managed largely by our patient along with her primary care doctor After her TV replacement she had three episodes of TV thrombosis, for which she received thrombolytics. Our patient complained that she could not hear the click of her mechanical valve She was hemodynamically stable with a heart rate of 105 beats per minute. Thrombolytics were not an option as she was in a recent postoperative state She was maintained under close observation and serial echocardiograms showed that the gradients across her TV remained stable. Our patient tolerated the procedure well and went home in stable condition

Discussion

Findings

Conclusion

Alpert JS