Mechanical heart valves are recommended in mitral valve disease patients aged <65 years or aortic valve disease patients aged <60 years with a reasonable life expectancy and no contraindications to long-term anticoagulation.¹ This recommendation was made because of the durability of the mechanical prosthesis over bioprosthesis. However, the durability of the mechanical valve is often challenged by obstructive thrombus as early as the first year. Redo surgery or fibrinolysis in high-risk surgery patients is the currently available evidence-based treatment.¹Percutaneous transcatheter release of stuck valve (PETROS) with cerebral embolic protection for left sided mechanical valves is the upcoming therapeutic modality.^2,3 The mechanical heart valve thrombosis incidence ranges from 0.1% to 5.7%.⁴ Redo cardiac surgery often ends in a new valve replacement with a bioprosthetic valve, though few reports of thrombus removal or pannus removal are available in the literature.⁴ Ultra-slow infusion of fibrin-specific fibrinolytic agent has shown promise over bolus fibrinolysis. Yet, the failure to release the stuck leaflets or embolic stroke and systemic embolism were seen as dreadful complications.⁵ In this study we determine the short-term and long-term outcomes of these three treatment modalities namely surgery, PETROS and Fibrinolysis.