Bjork Shiley Aortic Valve Replaced After 32 Years

Bjork Shiley valve developed in 1969, after Ball valve and Ball-Cage valve and tilting disc valve of Lillehei-Kaster. It was a hingeless pivoting disc valve with welded struts and occluder disc. Though it has improved hemodynamic performance it has high thrombosis and disc embolisation potential.

Fig 1: The old Bjork Shiley valve in my hand, immediately after extraction from the patient.

Since its discovery, the Food and Drug Administration has not approved the valve for the Americans. Hence the americans have choosen a dumping place in Australia, Europe and India. You can say it was one of the biggest human experimentation ever done. Thousands of people who had been implanted with this valve had a time bomb ticking inside their chest and can explode anytime leaving them dead within seconds.

Hundreds have died and many counting their turn. Luckily we have a patient with this valve placed in his heart 32 years back. God, alive! Good to see it beating. He has been symptomatic since 1 month with breathlessness and palpitation. 2D Echocardiography showing pannus in the vicinity of the prosthesis with mean pressure gradient of 42mm Hg across aortic valve. The patient had been operated when he was 16 years old and as lucky always his ventricular functions were preserved with LVEF=65%.

When Americans have not approved this valve in their own country they have made this valve circulated in rest of the world. Holy God! Humans have been made guinea pigs. When the struts of these valve crack, you die any time without any premonition symptoms. Once the valve exploded there is nothing anybody can do. There will be only one option left for you, that is to die. The bomb ticking inside you can stop ticking anytime, it could be now or some months later but once it does, you have to stop breathing. What a shame!! Thank God, our patient has survived. You can say the longest survivor.

I was curious to see the valve how it looks as it is. I have already told OT staffs to keep the valve for me when it will be replaced. Before i got the valve in my hand i had seen it in the internet and the Chest X Ray of the patient.

Fig 2: This is the Chest X Ray Lateral view showing the Bjork Shiley valve with occluder disc.

He underwent Redo Surgery. Midline sternotomy was not difficult to perform as there had enough space. God had helped this lucky man all along; from his teen to late forties life had been smooth.

He got extubated and sipping some juices in the recovery room; when i showed him the 60 degree tilting occluder disc, he was amazed. As I was ticking the occluder disc to its struts, he said ” I was hearing the same sound inside my chest”. When he doubted the strength of the struts, I told, ” you are really lucky not to have any of those broken with million of beats year after year.”

 

 

Cardiac Surgery in Post Hemimandibulectomy for Oral Cancer

A 58 year old non-diabetic and normotensive male patient presented to the hospital with complaints of breathlessness and history of pre syncope since 4 months.

Fig 1: Old scar mark of the Pectoralis Major Myocutaneous flap for oromandibular reconstruction for oral cancer. Frest chest wound of the present midsternotomy.

He was diagnosed with Severe AS, Severe AR, Moderate MR, Severe TR and AF.

The features need discussion is about his unilateral appearance of beard. After Pectoralis Major Myocutaneous Flap on the right, he had normal appearance of beard on both side initially but later he had only beard on the healthy side, i.e, the left.

 

 

 

Fig 2: Unilateral appearance of the beard on the healthy side after oromandibular reconstruction done 7 years back.

History revealed initially he had also hairs inside his mouth. He had received radiation therapy and probably this is the reason of non appearance of beard on the affected side.

He had underwent Hemi-mandibulectomy  7 years back for oral cancer. He was evaluated and underwent Aortic Valve replacement with Tricuspid Ring Annuloplasty.

His post operative recovery was normal. Respiratory effort was normal as he was performing incentive spirometry very well. Will be discharged in a day or two.