[A successful emergency reoperation of thrombosed CarboMedics valve in the mitral position]

We report a successful emergency reoperation of a thrombosed CarboMedics valve five years after the original implantation of the prosthesis. A 53-year-old mentally retarded woman suffered acute heart failure due to a thrombosed CarboMedics valve, which was caused by inadequate control of anticoagulants. The patient was reoperated on immediately after thrombolytic therapy failed to show an improvement in leaflets' excursion. The excised prosthesis demonstrated that organized thrombi originating at both sides of the hinge portions extended to the atrial side of one of the leaflets. The bileaflet valve is supposed to prohibit catastrophic heart failure by preventing simultaneous malfunction of both leaflets. However, we believe that prompt surgical treatment is essential even for the thrombosed bileaflet valve, because a thrombus originating in the hinge area seems to develop into a fatal simultaneous malfunction of both leaflets.