Seven patients with massive thrombosis on a Bjork-Shiley aortic valve prosthesis are described. This complication was documented in 5 percent of our patients with a Bjork-Shiley valve and occurred 3 to 19 months (mean 13 months) after insertion of the prosthesis. Only one patient had adequate anticoagulant therapy at the time of diagnosis. All patients had acute or subacute clinical deterioration. Anginal chest pain was the presenting symptom in four patients, and acute left ventricular failure in three. In all patients, the closing click of the Bjork-Shiley prosthesis was not heard, and new aortic systolic or diastolic murmurs were audible. Cardiac catheterization and aortic root cinearteriography were performed in five patients. Severe prosthetic regurgitation was found In four patients and mild regurgitation in one. Abnormal disc motion-fixation of the disc in the open position, abnormal limited opening of the disc or imperfect closure-was demonstrated in all arteriographic studies. Echocardiograms revealed an immobile disc in two patients. Five patients were surgically treated by thrombectomy and debridement of the prosthetic valve; the original prostheses were left in situ. Four of these patients are alive and one died. Two patients who did not undergo surgical treatment died. Thrombosis on the Bjork-Shiley aortic valve has a high fatality rate. Suspicion of this complication should be followed by emergency catheterization and surgery. In critically ill patients, surgery may be required even without angiography. The occurrence of this serious complication, mostly in patients with a normal coagulatory state, indicates the need for permanent anticoagulation in patients with a Bjork-Shiley aortic valve prosthesis.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine