Fatal thrombosis of the Starr-Edwards mitral valve prosthesis associated with bacterial endocarditis. Diagnostic significance of a disappearing prosthetic click.

A case of fatal thrombosis of Starr-Edwards mitral valve prosthesis associated with bacterial endocarditis is presented. The role of inadequate anticoagulation and bacterial endocarditis in the formation of massive thrombus on the valve prosthesis is discussed. The detection of disappearance of a dLstinct click sound in a patient with a previously functioning Starr-Edwards mitral valve prosthesis should arouse immediate suspicion of massive thrombosis of the prosthesis. The latter should constitute a surgical emergency as fatal outcome inevitably ensues unless the thrombosed prosthesis is replaced.