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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.
Insights
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.
Abstract:
Between April 1980 and June 1986, 274 patients underwent mitral valve replacement (MVR) with the Björk-Shiley (BS) standard disc mitral valve prosthesis at the American University of Beirut Medical Center (AUBMC). Eleven patients (3.9%) presented 6-41 months after surgery with prosthetic valve dysfunction due to thrombosis. Inadequate control of anticoagulation was the major factor predisposing to thrombosis in all except one. All patients had documented rheumatic valvular disease. Nine patients were operated on an emergency basis and two died before any surgical intervention was possible. Thrombectomy was performed on six patients with four survivors and MVR in three with two survivors. Two patients died intraoperatively (22%). Three pregnant patients underwent mechanical declotting; pregnancy was terminated by abortion in 2 and by caesarean section and live birth in one. We conclude that implantation of the BS mitral valve prosthesis mandates emphasis on anticoagulation and the difficulty encountered with continuous anticoagulant therapy in pregnancy.