Replacement of a thrombosed St. Jude Medical prosthesis in pulmonary position after repeated thrombolytic therapy.

A 49-year-old man who had undergone repair of tetralogy of Fallot underwent replacement of a thrombosed St. Jude Medical prosthesis in pulmonary position after intravenous thrombolytic therapy. Dysfunction of the prosthetic valve was detected clinically by change of heart sound and the appearance of a new diastolic murmur. Cinefluoroscopy confirmed fixation of both leaflets. Although thrombolytic therapy using urokinase was successful twice, the prosthesis was replaced with a Carpentier-Edwards bioprosthesis due to recurrent prosthetic dysfunction.