Thrombectomy: surgical treatment of the thrombosed Björk-Shiley prosthesis. Report of seven cases and review of the literature.
Among 1,000 patients with 1,225 Björk-Shiley prostheses, we have detected 12 cases (0.98%) of late thrombosis of the Prosthesis, seven of which were successfully managed by thrombectomy. A review of other authors' experience with this procedure shows no deaths directly attributable to thrombectomy, although two patients had cerebral embolization during the procedure. For prevention of this complication, we propose that both the aorta and the left atrium be explored during thrombectomy of either the mitral or the aortic prosthesis so as to achieve complete exposure of the left ventricular outflow tract and complete removal of any thrombus located in the ventricle. We consider this the procedure of tract and complete removal of any thrombus located in the ventricle. We consider this the procedure of choice in thrombosis of the Björk-Shiley prosthesis. Replacement of the prosthesis would then be restricted to cases of prosthesis damage or those in which adequate anticoagulation cannot be maintained.
D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology / Q000517:prevention & control; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*