BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7005.638 (Published 02 September 1995) Cite this as: BMJ 1995;311:638

Between 1979 and 1986 around 86000 Bjork-Shiley plastic heart valves were implanted into patients. Fractures of the valves began to be reported in the first year of their use, and though the design was modified and improved, the manufacturer stopped production in 1986. So far 564 valves are known to have failed, with a mortality of 67% (New England Journal of Medicine 1995;333:414-9). Apparently one leg of the strut often breaks before the other, and a cineradiography technique has been developed that allows the identification of valves at high risk of failure--and so provides a basis for giving advice to the 47000 patients still living with these valves who are considering having an operation to remove them.

Snake bite must be one of the rarest, most exotic causes of myocardial infarction, though some snake venoms are known to have a vasoconstrictive effect on the coronary arteries. A case report in “Tropical Doctor” (1995;25:137) describes an Indian man aged 45 who complained of breathlessness 29 hours after being bitten by a viper, for which he was treated by polyvalent antivenom. An electrocardiogram showed evidence of recent acute myocardial infarction, which was …

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