Percutaneous Mechanical Mobilization of a Thrombosed Mechanical Tricuspid Valve After Failed Thrombolysis

Mechanical prosthetic tricuspid valve thrombosis is a rare but potentially life-threatening condition. Evidence guiding management is limited, particularly in patients who are poor surgical candidates or who fail thrombolytic therapy. We report an 83-year-old woman with a mechanical tricuspid valve who presented with progressive right-sided heart failure due to obstructive valve thrombosis. After failure of anticoagulation and low-dose thrombolytic therapy, a percutaneous catheter-based approach was performed. Using a steerable sheath and electrophysiology catheter, mechanical mobilization of the stuck leaflet was achieved, followed by thrombus aspiration. Leaflet mobility was restored, and transvalvular gradients significantly improved without complications. In carefully selected patients with mechanical tricuspid valve thrombosis who are not candidates for surgery and fail thrombolytic therapy, percutaneous mechanical mobilization may represent a feasible and effective bailout strategy.