Diagnosis and treatment of obstruction of a tricuspid Björk-Shiley prosthesis
Beeuwsaert, R.; Denef, B.; De Geest, H.
Acta Cardiologica 38(1): 13-25
1983
ISSN/ISBN: 0001-5385 PMID: 6601892 Document Number: 219045
Obstruction of a tricuspid Bjork-Shiley prosthesis was diagnosed in 7 patients, caused by thrombus formation in 6, and tissue overgrowth in 1. In 5 patients in whom the tilting disc had a ring shaped radiopaque marker, cineradiographic studies revealed incomplete opening (< 60 degrees) and or closure of the prosthetic valve disc. In 6 patients the most reliable phonocardiographic signs were the presence of a delayed and prolonged diastolic mid-frequency rumble at the 3rd left intercostal space, increasing on inspiration, and the absence of the opening sound of the tricuspid prosthetic valve. In 5 patients the M mode echocardiographic pattern of diastolic motion of the obstructed valve disc was very characteristic and showed a delayed and rounded upstroke and downstroke, and a reduced amplitude of diastolic excursion of the valve disc. In 1 patient in whom parasternal M mode echocardiography did not identify the obstructed valve, valve obstruction was clearly demonstrated by bidimensional echocardiography from the apical 4 chamber view. Apparently, echocardiography is a useful tool for the diagnosis of tricuspid prosthetic valve obstruction, especially when the valve disc has no ring chaped radiopaque marker. Four patients were treated with streptokinase. This treatment was successful in 3 patients, but failed in the patient in whom the tricuspid valve obstruction was caused by tissue overgrowth. Fibrinolytic therapy before surgical reintervention is recommended.