Organized Thrombus of Tricuspid Valve

To the Editor: We read with great interest the case report by Paolillo and coworkers about their experience in a patient with coronary artery disease and the incidental finding of organized tricuspid valve thrombus.1 We recently described a similar entity, encountered in a different clinical scenario.2 A young woman was referred to us for excision of a tricuspid valve tumor. She had clinical features suggestive of episodes of recurrent pulmonary embolism, in a setting of recent use of oral contraceptive pills and in the presence of uterine fibroids. No pulmonary emboli or deep vein thrombi were detected. The mass was excised using cardiopulmonary bypass and was found on histopathologic examination to be an organized thrombus. We agree with the authors that the development of thrombus on a tricuspid valve is a very rare problem. This lesion usually mimics tumor or infective endocarditis. We suspect that in our case the thrombus embolized from the deep veins of a lower limb or from the pelvic veins and got entrapped in the mechanism of the tricuspid valve. A contributing factor might have been minor endothelial injury to the endocardium of the tricuspid valve in the presence of moderate pulmonary hypertension as a result of recurrent pulmonary embolism. It seems that natural fibrinolysis mechanisms failed to lyse the thromboemboli in these 2 cases. Pankaj Saxena, MCh, DNB Registrar, Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia Robert Tam, FRACS Consultant Cardiothoracic Surgeon, The Prince Charles Hospital, Chermside, Australia