Key result
Low-dose ultra-slow tPA infusion successfully manages mechanical tricuspid prosthetic valve thrombosis under serial fluoroscopic guidance.
Why the study?
Right-sided prosthetic valves may not be evaluated precisely by transesophageal echocardiography during follow-up of thrombolytic therapy, making serial fluoroscopy an alternative noninvasive imaging method to assess leaflet motion.
Case Report (n=1)
Serial fluoroscopy can be a valuable alternative imaging method to guide low-dose, ultra-slow thrombolytic therapy for mechanical tricuspid prosthetic valve thrombosis when echocardiography is insufficient.
May succeed in select tricuspid prosthetic thrombosis cases when echocardiography is limited; hypothesis-generating and requires prospective validation.
Prosthetic valve thrombosis is a life-threatening complication that is seen most commonly in patients with left-sided prosthetic valves. However, mechanical tricuspid valves carry the highest risk of thrombosis of any cardiac valve. Thrombolysis has been performed successfully in right-sided prosthetic valve thrombosis and has been recommended as the first-line treatment in these patients. Although two-dimensional and real-time three-dimensional transesophageal echocardiography are the gold standard imaging modalities for the diagnosis of prosthetic valve thrombosis, right-sided prosthetic valves may not be evaluated precisely. This is a serious problem during the follow-up of patients who receive thrombolytic therapy for tricuspid valve thrombosis. Fluoroscopy is an alternative noninvasive imaging method that provides valuable information about leaflet motion and may be used for such cases with restricted leaflets. Herein, we report a case of tricuspid valve thrombosis who was managed with low-dose (25 mg) and ultra-slow (25 hours) infusion of tissue-type plasminogen activator under the guidance of serial fluoroscopy.
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Macit Kalçık (2014) conducted a case report in Mechanical tricuspid prosthetic valve thrombosis (n=1). Tissue-type plasminogen activator under serial fluoroscopy guidance was evaluated. A case of mechanical tricuspid prosthetic valve thrombosis was managed with a low-dose (25 mg) and ultra-slow (25 hours) infusion of tissue-type plasminogen activator guided by serial fluoroscopy.
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