{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T02:00:41Z","timestamp":1784858441706,"version":"3.55.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":58,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Bj\u00f6rk\u2013Shiley monostrut (BS-M) valve, a tilting-disc mechanical prosthesis introduced to improve durability and reduce structural failure, has demonstrated excellent long-term outcomes in the aortic position. Although structural valve deterioration is rare, non-valvular complications such as pannus formation can necessitate reoperation. We report a rare case of revision aortic valve replacement 40\u00a0years after BS-M implantation due to subaortic stenosis caused by pannus formation, utilizing a Perceval sutureless valve to minimize operative risk in the context of impaired cardiac function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>An 80-year-old Japanese man with a BS-M valve implanted in the aortic position 40\u00a0years earlier presented with syncope and progressive heart failure. He had a history of bradycardic atrial fibrillation and had been managed medically for heart failure over the preceding seven years. Transthoracic echocardiography revealed severe aortic stenosis, moderate mitral stenosis, and moderate tricuspid regurgitation, with a significantly reduced ejection fraction. Although the BS-M valve itself exhibited no mechanical damage or disc dysfunction intraoperatively, circumferential pannus formation beneath the prosthesis caused significant subvalvular stenosis. The patient underwent aortic valve re-replacement with a Perceval\u2122 sutureless valve, mitral valve replacement, tricuspid annuloplasty, and left atrial appendage closure. The choice of a sutureless valve was made to reduce myocardial ischemia time. Postoperatively, the patient experienced aspiration pneumonia requiring reintubation; however, he recovered and was transferred to rehabilitation on postoperative day 21. Follow-up echocardiography revealed satisfactory valve hemodynamics and improved ventricular function, with no evidence of prosthetic valve dysfunction. At 8-month follow-up, the patient remained well.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights the exceptional structural durability of the BS-M valve even after four decades. Nonetheless, non-valvular complications such as pannus formation may necessitate reoperation. Long-term surveillance remains essential for early detection of functional decline, even in patients with structurally intact prosthetic valves.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13256-026-06151-3","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T19:33:11Z","timestamp":1779910391000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Revision aortic valve replacement with a Perceval sutureless valve 40\u00a0years after Bj\u00f6rk\u2013Shiley monostrut valve: a case report"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9272-1953","authenticated-orcid":false,"given":"Yasuhiro","family":"Matsuda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadaaki","family":"Koyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"6151_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3109\/14017436909131912","volume":"3","author":"VO Bj\u00f6rk","year":"1969","unstructured":"Bj\u00f6rk VO. A new tilting disc valve prosthesis. Scand J Thorac Cardiovasc Surg. 1969;3:1\u201310.","journal-title":"Scand J Thorac Cardiovasc Surg"},{"key":"6151_CR2","first-page":"1","volume":"42518","author":"JN Fabiani","year":"1989","unstructured":"Fabiani JN, Perier P. The cardiac valvular prostheses. Encycl Med Chir. 1989;42518:1\u201314.","journal-title":"Encycl Med Chir"},{"key":"6151_CR3","first-page":"57","volume":"86","author":"RZ Omar","year":"2001","unstructured":"Omar RZ, Morton LS, Halliday DA, Danns EM, Beirne MT, Blot WJ, et al. Outlet strut fracture of Bjork\u2013Shiley convexo-concave heart valves: the UK cohort study. Heart. 2001;86:57\u201362.","journal-title":"Heart"},{"key":"6151_CR4","doi-asserted-by":"crossref","first-page":"485","DOI":"10.4326\/jjcvs.16.485","volume":"16","author":"T Shinoka","year":"1987","unstructured":"Shinoka T, Nakano S, Imamura E, Endo M, Hashimoto A, Koyanagi H. An analysis of valve re-replacement after valve replacement with Bj\u00f6rk\u2013Shiley valve. Jpn J Cardiovasc Surg. 1987;16:485\u20137.","journal-title":"Jpn J Cardiovasc Surg"},{"key":"6151_CR5","doi-asserted-by":"publisher","first-page":"e283","DOI":"10.1016\/j.athoracsur.2016.03.082","volume":"102","author":"JM Gonzalez","year":"2016","unstructured":"Gonzalez JM, Arn\u00e1iz-Garc\u00eda ME, Dalmau-Sorl\u00ed MJ, Sastre-Rinc\u00f3n JA, Hern\u00e1ndez-Hern\u00e1ndez J, P\u00e9rez-Losada ME, et al. Complete transversal disc fracture in a Bj\u00f6rk\u2013Shiley Delrin mitral valve prosthesis 43 years after implantation. Ann Thorac Surg. 2016;102:e283-285.","journal-title":"Ann Thorac Surg"},{"key":"6151_CR6","doi-asserted-by":"publisher","first-page":"247","DOI":"10.4326\/jjcvs.46.247","volume":"46","author":"K Terazono","year":"2017","unstructured":"Terazono K, Ueno T, Toyokawa K, Fukumoto Y, Yamashita M, Moriyama Y. Bj\u00f6rk\u2013Shiley prosthetic valve dysfunction caused by complete disc fracture. Jpn J Cardiovasc Surg. 2017;46:247\u201350.","journal-title":"Jpn J Cardiovasc Surg"},{"key":"6151_CR7","doi-asserted-by":"publisher","first-page":"29","DOI":"10.4326\/jjcvs.52.29","volume":"52","author":"R Ikeda","year":"2023","unstructured":"Ikeda R, Kikuchi C, Tsuboko Y, Ikehara M, Watanabe S, Yamada Y, et al. A case of redo-mitral valve replacement for a Bj\u00f6rk\u2013Shiley Delrin valve implanted 47 years previously. Jpn J Cardiovasc Surg. 2023;52:29\u201333.","journal-title":"Jpn J Cardiovasc Surg"},{"key":"6151_CR8","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1093\/icvts\/ivv348","volume":"22","author":"MA Soofi","year":"2016","unstructured":"Soofi MA, Ignaszewski MT, Ashton TH, Miyagishima RT. Longest follow-up of in situ working Bj\u00f6rk\u2013Shiley valve: 42-year follow-up. Interact Cardiovasc Thorac Surg. 2016;22:375\u20137.","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"6151_CR9","first-page":"1986","volume":"44","author":"M Hirai","year":"1996","unstructured":"Hirai M, Kitamura M, Aomi S, Hatta M, Nakano H, Otsuka G, et al. Long-term results of cardiac valve replacement with a Delrin-disk model of the Bj\u00f6rk\u2013Shiley valve prosthesis-comparative analysis with the spherical-disk model. Jpn J Thorac Cardiovasc Surg. 1996;44:1986\u201392.","journal-title":"Jpn J Thorac Cardiovasc Surg"},{"key":"6151_CR10","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.3346\/jkms.2007.22.6.1060","volume":"22","author":"H Ahn","year":"2007","unstructured":"Ahn H, Kim KH, Kim DJ, Jeong DS. Long-term experience with the Bj\u00f6rk\u2013Shiley monostrut tilting disc valve. 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Jpn J Cardiovasc Surg. 2021;50:170\u20133.","journal-title":"Jpn J Cardiovasc Surg"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-026-06151-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06151-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-026-06151-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T01:04:20Z","timestamp":1784855060000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13256-026-06151-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6151"],"URL":"https:\/\/doi.org\/10.1186\/s13256-026-06151-3","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]},"assertion":[{"value":"20 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Institutional Review Board of Kansai Medical University through an expedited review process.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"423"}}