인공삼첨판막의 혈전에 의한 삼첨판막 협착증의 임상상과 치료

Background: Thrombosis of prosthetic valve occurs more frequently in the mechanical prosthetic valve than tissue valve and more frequently in right-side heart than left-side heart. This study shows the clinical characteristics and treatment of bileaflet prosthetic valve thrombosis in the tricuspid position. Methods: Patients with bileaflet prosthetic valve in tricuspid position were followed till clinically significant tricuspid stenosis due to thrombosis develops. Five patients had clinically significant thrombotic tricuspid stenosis. Diagnosis was based on history taking, physical examaination, echocardiograpy and cinefluoroscopy. Results: Anticoagulation therapy was inadequate in 4 of 5 patients. Prosthetic valve replacement was undertaken in one patient and four patients were treated with thrombolytic therapy using urokinase. Three patients among 4 patients managed with thrombolytic therapy were successfully treated. There was no serious complication. Cinefluoroscopy and echocardiography were useful in diagnosis and evaluation of the thrombolysis. Conclusions: Thrombolytic therapy is useful as an initial treatment of thrombosed tricuspid prosthetic valve stenosis without major complications.