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Thrombosed Björk-Shiley standard disc mitral valve prosthesis.
1Department of Surgery, American University of Beirut School of Medicine and Medical Center (AUBMC), Lebanon.
The Journal of Cardiovascular Surgery
|November 1, 1989
Summary
Björk-Shiley mitral valve thrombosis occurred in 3.9% of patients due to inadequate anticoagulation control. Management challenges, especially during pregnancy, highlight the need for careful anticoagulant monitoring after mitral valve replacement.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Medicine
Background:
- The Björk-Shiley (BS) standard disc mitral valve prosthesis was implanted in 274 patients between 1980 and 1986.
- Prosthetic valve dysfunction due to thrombosis is a known complication.
- Rheumatic valvular disease was a common comorbidity in the patient cohort.
Purpose of the Study:
- To evaluate the incidence and management of prosthetic valve dysfunction due to thrombosis after mitral valve replacement (MVR) with the BS prosthesis.
- To identify predisposing factors for thrombosis.
- To assess outcomes of interventions and challenges in pregnant patients.
Main Methods:
- Retrospective analysis of 274 patients who underwent MVR with the BS prosthesis.
- Review of clinical data, including presentation of prosthetic valve dysfunction, predisposing factors, and interventions.
- Specific focus on outcomes in patients presenting with thrombosis, including surgical interventions and pregnancy-related cases.
Main Results:
- Eleven patients (3.9%) developed prosthetic valve dysfunction due to thrombosis 6-41 months post-MVR.
- Inadequate anticoagulation control was the primary predisposing factor in all but one patient.
- Surgical interventions (thrombectomy or re-MVR) had a 66.7% survival rate; 22% of patients died intraoperatively. Three pregnant patients underwent mechanical declotting with varied outcomes.
Conclusions:
- Implantation of the BS mitral valve prosthesis necessitates rigorous anticoagulation management.
- Continuous anticoagulant therapy presents significant challenges, particularly in pregnant patients.
- Early recognition and intervention are crucial for managing BS mitral valve thrombosis.