Cardiac valve prostheses at autopsy.

We describe the pathologic findings at autopsy in 96 persons who had undergone prosthetic heart valve implantation. The most common indication for implantation was rheumatic heart disease (58%), followed by infective endocarditis (22%). Cardiac failure led to death in two thirds of the cases, most often from infective endocarditis (18%) and congestive heart failure (13%). Failure of the prosthetic valve caused death in eight cases. There were 13 deaths intraoperatively or in the immediate postoperative period. Patients with mechanical prostheses survived longer than did those with bioprostheses. The most common prosthesis-related complication was thrombosis, found in 23% of mechanical valves and 11% of bioprostheses. Thrombosis led to death in only 4 cases. Thromboembolic phenomena led to nine deaths and were not related to anticoagulant therapy. These findings provide an approach to investigation, description, and diagnosis of prosthetic heart valves at autopsy.