A case of stuck mechanical Tricuspid Valve | Pakistan Journal of Medical Sciences 2024

Author(s)

Abdul Nasir Department of Cardiothoracic Surgery, Peshawar Institute of Cardiology, Peshawar, Pakistan.

Mujeeb Ur Rehman Department of Pediatric and Congenital Heart Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, Pakistan.

Salman Khan Department of Cardiothoracic Surgery, Faisalabad Institute of Cardiology, Faisalabad, Pakistan.

Hamza Ali Bannu Medical College, Bannu, KPK, Pakistan.

Abstract

SUMMARY A 34-year-old non hypertensive, non-diabetic and ill looking weak woman came to our emergency department with shortness of breath NYHA III-IV, severe bilateral pedal edema extending up to the thighs and gross ascites. Physical examination revealed 3mm pitting ankle and leg edema and hemodynamically was stable with raised jugular venous pressure. There was a closing and opening mechanical click on Cardiac auscultation. At the lower left sternal border, there was grade 2/6 holodiastolic rumble and a grade 2/6 systolic murmur. She had history of mitral valve replacement and tricuspid valve replacement in 2017 with mechanical valves then she had Redo tricuspid valve replacement with mechanical prosthesis again after four months. No known food or drug allergy and psychosocial issues. Her routine bloods Labs were normal and COVID-19 was negative. On chest X-ray P/A view images and echo showed markedly gross left sided pleural efusion. In Coronary angiogram showed normal coronaries and stuck tricuspid valve (Fig.1). Echocardiography report showed preserved LV systolic function (EF=57%), dilated left atrium and right atrium. Prosthetic mitral valve was seen at mitral position, well seated and well-functioning. The mechanical mitral valve was functioning well with normal disc motion with no thrombus formation. Prosthetic tricuspid valve was seen at tricuspid level with peak gradient of 22mmHg and shown stuck mechanical tricuspid discs stuck throughout the cardiac cycle, in a fully open position (Fig.2A and 2B). Atrial fibrillation was shown on ECG. The diagnosis was made as; pannus formation resulting in mechanical TV thrombosis.

Publication Details

Page(s) 247-250

DOI 10.12669/pjms.40.1.8362

Published Journal: Pakistan Journal of Medical Sciences, Volume: 40, Issue: 1, Year: 2024

Keywords

mechanical Biological prosthesis Tricuspid

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