Pathology of heart valve replacement surgery: autopsies of 62 patients with Starr-Edwards prostheses.

Hemorrhage in the atrioventricular conduction system and myocardial necrosis commonly occur in the first week after valve replacement. Later, thrombosis on the prosthesis and infarcts in other organs become important but developing or persistent myocardial damage continuously menaces. Occlusion of small vessels, especially by embolism of foreign material, may contribute to the development of these lesions. Although the exfracorporeal circulation, anticoagulation, cardiac pacing and steroid therapy generally applied to patients undergoing Starr-Edwards valve replacement either are necessary to the surgery or effectively overcome some potent dangers, these p actices may disguise progression to more serious levels of some maladies induced by operation. Data accumulating from these autopsies and from clinical records include many and varied complications of surgery.