Thrombosed Björk-Shiley mitral prostheses.

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Abstract
Twelve patients presented 3-43 mo. (mean 17 mo.) after surgery with thrombosis of their mitral prostheses. A clinical syndrome consisting of acute onset of ischemic or pleuritic chest pain, dyspnea and right-sided cardiac failure is described. The prosthetic sounds, especially the opening click, are invariably absent or markedly muffled, but definitely abnormal mitral murmurs are infrequently detected. The echocardiogram is a useful adjunct in confirming the diagnosis. Total thrombotic encapsulation of the prosthesis may supervene within hours or days and is invariably fatal unless there is surgical intervention. One patient died because there was no immediate correct diagnosis. Early recognition of the clinical features resulted in successful valve replacement. There were 19 deaths among the 224 patients. Seven of them died because of thrombotic occlusion of their mitral prostheses. Poor anticoagulant control was the principal factor predisposing to prosthetic thrombosis. Eighteen patients (8%) sustained this complication. Neither the original mitral valve lesion nor the size of the Bjork-Shiley prosthesis was relevant. The Bjork-Shiley prosthesis for mitral valve replacement should not be used when ideal control of anticoagulant therapy.

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