Late Thrombosis of the Aortic Bjork-Shiley Prosthesis

Fernández, Javier; Samuel, A. L.; Yang, Sheng‐An; Sumathisena,; Gooch, Alden S.; Maranhão, Vladir; Lemole, Gerald M.; Goldberg, Harry

doi:10.1378/chest.70.1.12

Cited by 51 publications

(7 citation statements)

References 10 publications

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“…3); the development of a faint diastolic murmur in cases 2, 3, and 13; and finally the following carotid pulse modifications: increase of ejection time in two cases (3,13), increase of half-rise time in all cases, and a coexistent slight "aortic stenosis-like" pattern with modification of the incisura in all cases.…”

Section: Resultsmentioning

confidence: 93%

Fibrinolytic treatment of thrombus on prosthetic heart valves.

Witchitz¹,

Veyrat²,

Moisson³

et al. 1980

Heart

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Fibrinolytic agents were administered for 13 episodes of thrombus formation on mitral or aortic valvar prostheses in 12 patients. The most common presenting features were pulmonary oedema (six cases) or arterial emboli (six cases). The diagnosis of thrombus formation was made by phonocardiography on the following criteria: (a) modifications of the prosthetic sounds (12 cases), (b) appearance of a valvar obstructive syndrome (10 cases). The treatment consisted of streptokinase (100 000 units/h after a loading dose, seven cases) or urokinase using either low doses (75 000 or 112 500 units/h, three cases) or moderate doses (150 000 units/h, three cases) for one to four days. Immediate complete regression of clinical and phonocardiographic anomalies was seen in eight cases. Incomplete improvement was seen in two patients, leading to operation: this was unsuccessful in one patient who had surgery on the third day, and was successful in the other on the 75th day. There were three failures leading to successful reoperative procedures in two patients and to an early death in the third patient suffering from acute myocardial infarction. One non-fatal haemopericardium was observed in a patient treated with streptokinase. No important side effect was noted during delivery in a pregnant woman. During subsequent follow-up, a recurrent episode of thrombus formation was observed in one patient, treated by fibrinolytic therapy with success. One patient had an operation for a valve replacement six months after fibrinolytic treatment because of non-thrombotic valvar dysfunction; the outcome was fatal. Six patients are alive and in good condition, with a follow-up of six months to five years.

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Section: Resultsmentioning

confidence: 93%

Fibrinolytic treatment of thrombus on prosthetic heart valves.

Witchitz¹,

Veyrat²,

Moisson³

et al. 1980

Heart

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“…The zone of stagnation is about 10 mm wide across the face of the disc (dimension L1 in Fig. We believe that the zone of stagnation observed in the near vicinity of the aortic face of the present model Bjork-Shiley disc encourages the formation of thrombi on the aortic face (Roberts & Hammer, 1978;Ben-Zvi et al, 1974;Fernandez et al, 1976;Cokkinos et al, 1971;Bozer & Karamehmetoglu, 1972;Yoganathan et al, 1978). The size of the stagnation zone observed is relatively constant over a flow rate range of 167 cm3/sec (10 I/min) to 417 cmYsec (25 I/min).…”

Section: Discussionmentioning

confidence: 77%

“…The prosthesis has undergone various modifications in design and materials since its initial use. Over the past few years it has been observed that thrombus formation on the aortic face of the disc could lead to impaired or abolished mobility of the tilting disc (Bjork, 1977;Roberts & Hammer, 1976;Ben-Zvi et al, 1974;Fernandez et al, 1976;Cokkinos et al, 1971;Bozer & Karamehmetoglu, 1972;Yoganathan et al, 1978). The Delrin disc, however, caused autoclaving and handling problems during surgery (Bjork, 1977).…”

mentioning

confidence: 99%

The Björk – Shiley Aortic Prosthesis: Flow Characteristics of the Present Model vs. The Convexo-Concave Model

Yoganathan¹,

Reamer²,

Corcoran³

et al. 1980

Scandinavian Journal of Thoracic and Cardiovascular Surgery

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Thrombus formation on the aortic face of the disc and tissue overgrowth along the sewing ring adjacent to minor outflow region are major clinical pathologic findings observed with the present model Björk-Shiley aortic prosthesis. These pathologic findings may be attributed to the stagnation zone observed near the aortic face of the disc, and the low flow and shear in the minor outflow region of the prosthesis. In hope of reducing these pathologic conditions the new convexo-concave Björk-Shiley prosthesis was developed. In vitro velocity measurements made with a laser-Doppler anemometer in the immediate downstream vicinity of the convexo-concave Björk-Shiley aortic valve indicate that the design changes have decreased the size of the stagnation zone and have increased flow and shear in the minor outflow region. We conclude that the problems of thrombus formation and tissue overgrowth may be reduced in the new convexo-concave Björk-Shiley aortic valve.

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“…Increased incidence of thromboembolic complications has been attributed to irregular anticoagulation therapy, which might have been associated with a rebound hypercoagulable state; 2 while inadequate anticoagulation is considered the main cause of valve thrombosis. 4 Surgical treatment of prosthetic valve thrombosis has been by thrombectomy or replacement of the prosthetic valve or both. 4,5 Thrombectomy was considered the procedure of choice in many series 12 because it is easy and fast to perform and is a safe procedure in critically ill patients.…”

Section: Kale Thrombectomy With Rotation Of Valve Discmentioning

confidence: 99%

“…3 The main cause of valve thrombosis has been attributed to inadequate systemic anticoagulation. 4 In view of the sudden precipitous deterioration in hemodynamic functions and the high mortality associated with reoperation in these critically ill patients, an easy and safe procedure is required. The surgical option available for thrombosed tilting disc valves is thrombectomy or replacement of the prosthesis or both.…”

Section: Introductionmentioning

confidence: 99%

Thrombectomy with Disc Rotation of Medtronic Valves

Kale

Saksena

Agnihotri

et al. 2003

Asian Cardiovasc Thorac Ann

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Thrombotic obstruction of prosthetic valves is a serious problem. Early diagnosis and prompt treatment are life-saving in these cases. Three patients presented with subacute and chronic symptoms of prosthetic valve thrombosis of varying duration (7 days to 2 years). All 3 had a Medtronic Hall tilting disc valve implanted in a previous operation in the aortic or mitral position. Diagnosis was established by 2-dimensional echocardiography. Under cardiopulmonary or femorofemoral bypass, thrombectomy and rotation of the disc within the valve housing were performed through a median sternotomy. All the patients had an uncomplicated postoperative course. Pressure gradients fell markedly at discharge 8 to 10 days after surgery. The patients were followed up for between 3 and 11 months, during which they showed excellent prosthetic valve function and reduced gradients. The ability to rotate the valve within the housing allows adequate thrombectomy and pannus excision. Even several years after implantation (more than 10 years in 2 cases), the valve could still be rotated readily to obtain optimum flow and low pressure gradients.

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Late Thrombosis of the Aortic Bjork-Shiley Prosthesis

Cited by 51 publications

References 10 publications

Fibrinolytic treatment of thrombus on prosthetic heart valves.

Fibrinolytic treatment of thrombus on prosthetic heart valves.

The Björk – Shiley Aortic Prosthesis: Flow Characteristics of the Present Model vs. The Convexo-Concave Model

Thrombectomy with Disc Rotation of Medtronic Valves

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