Valvular thrombosis complicating tricuspid valve replacement: a case report

Valvular heart disease is cardiovascular pathology that affects over 100 million people worldwide and is associated with significant morbidity and mortality. Although tricuspid valve disease is the least common primary valve pathology, it is linked to a significantly increased mortality rate (up to 42% within 3 years). Valve thrombosis is a rare complication following mechanical valve replacement, characterized by thrombus accumulation on the valve leaflets, leading to limited valve movement, often in patients not achieving anticoagulation targets. Mechanical valve thrombosis is suspected in post-replacement patients presenting with acute or subacute symptoms. Rapid diagnosis relies on imaging modalities such as transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), computed tomography (CT), and fluoroscopy. This case report describes a 52-year-old male presenting with sudden onset dyspnea 5 days prior to hospital admission. The patient had a history of tricuspid valve replacement with a mechanical prosthesis due to tricuspid valve destruction by infective endocarditis vegetation, along with large muscular-inlet ventricular septal defect (VSD) closure and atrial septal defect (ASD) creation. Upon arrival, the patient appeared weak and dyspneic with unstable hemodynamics and was diagnosed with mechanical tricuspid valve thrombosis. Immediate valve replacement surgery was performed, but the patient unfortunately deceased 4 days postoperatively due to septic shock. We highlight the poor outcomes of prosthesis valve thrombosis and the need of prevention with regular surveillance and adequate anticoagulation strategies. The case also emphasizes the need for rapid diagnosis and management of mechanical valve thrombosis and the challenges in distinguishing it from other conditions such as pannus formation, emphasizing the importance of combining clinical and imaging criteria for accurate diagnosis and treatment.