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Echophonocardiographic Findings in a Patient With Aortic and Mitral Prostheses

Echophonocardiographic Findings in a Patient With Aortic and Mitral Prostheses Abstract A 33-year-old woman had undergone aortic and mitral valve replacement with Björk-Shiley prostheses in 1973 because of rheumatic valvular disease. She has been receiving digoxin and warfarin sodium since then. In November 1978, she noted the gradual onset of exertional dyspnea and orthopnea, which prompted her admission to the hospital. Physical examination disclosed a regular heart rate of 96 beats per minute, blood pressure of 120/70 mm Hg, and a grade 3/6 midsystolic murmur at the apex. A third sound of variable timing was noted. The ECG indicated left ventricular hypertrophy and left atrial enlargement only. A chest roentgenogram was compatible with congestive heart failure. Figure 1 is a simultaneous recording of the ECG, apical phonocardiogram (PCG), and mitral prosthetic valve echogram (PVE). What is your diagnosis? Diagnosis. —Malfunction of Björk-Shiley Mitral Prosthesis.Figure 2 is a higher paper-speed recording of the same graphics as in Fig 1. Note References 1. Bernal-Ramirez JA, Phillips JH: Echocardiographic study of malfunction of the Björk-Shiley prosthetic heart valve in the mitral position. Am J Cardiol 1977;40:449-453.Crossref 2. Clements SD, Perkins JV: Malfunction of a Björk-Shiley prosthetic heart valve in the mitral position producing an abnormal echocardiographic pattern. JCU 1978;6:334-336. 3. Felner JM, Schlant RC: Echocardiography: A Teaching Atlas. New York , Grune & Stratton Inc, 1976, pp 240-241. 4. Yuste P, Aza V, Minguez I, et al: Echocardiographic evaluation of mitral valve prosthesis malfunction , in Kazner E (ed): Ultrasonics in Medicine . Amsterdam, Excerpta Medica, 1975, pp 239-244. 5. Chun PC, Rajfer SI, Donohue DJ, et al: Björk-Shiley mitral valvular dehiscence documented by radiography, echocardiography, fluoroscopy, and cineangiography. Am Heart J 1980;99:230-234.Crossref 6. Carliner NH, Plotnick GD, Vassar DL, et al: Misleading noninvasive signs of Björk-Shiley mitral valve dysfunction. Johns Hopkins Med J 1978;143:160-162. 7. Busch UW, Mathur VS, Garcia E, et al: Echocardiography and prosthetic valve malfunction. Am J Cardiol 1978;42:690.Crossref 8. Jacovella G, Giampaolo P, Gambelli G, et al: Echocardiographic patterns of prosthetic valve malfunction. Am J Cardiol 1978;42:876.Crossref 9. Hildner FJ: Detection of prosthetic valve dysfunction by bedside and laboratory evaluation. Cardiovasc Clin 1973;5:289-306. 10. Gibson TC, Starek PJK, Moos S, et al: Echocardiographic and phonocardiographic characteristics of the Lillebei-Kester mitral valve prosthesis. Circulation 1974;49:434-440.Crossref 11. Zitnik RS, Burchell HB: A phonocardiographic study of patients with total prosthetic mitral valve replacement. Dis Chest 1963;44:11-17.Crossref 12. Berndt TB, Goodman DT, Popp RL: Echocardiographic and phonocardiographic confirmation of suspected caged mitral valve malfunction. Chest 1976;70:221-230.Crossref 13. Miller HC, Gibson DG, Stephens JD: Role of echocardiography and phonocardiography in diagnosis of mitral paraprosthetic regurgitation with Starr-Edwards prosthesis. Br Heart J 1973;35:1217-1225.Crossref 14. Brodie BR, Grossman W, McLaurin L, et al: Diagnosis of prosthetic mitral valve malfunction with combined echophonocardiography. Circulation 1976;53:93-100.Crossref 15. Schluger J, Mannix EP, Wolf RE: Auscultatory and phonocardiographic sign of ball variance in a mitral prosthetic valve. Am Heart J 1971;81:809-816.Crossref 16. Pfeifer J, Goldschlager N, Sweatman T, et al: Malfunction of mitral ball valve prosthesis due to thrombus. Am J Cardiol 1972;29:95-99.Crossref 17. Belenkie I, Carr M, Schlant RC, et al: Malfunction of a Cutter-Smeloff mitral ball valve prosthesis: Diagnosis by phonocardiography and echocardiography. Am Heart J 1973;86:399-403.Crossref 18. Kawai N, Segal BL, Linhart JH: Delayed opening of Beall mitral prosthetic valve detected by echocardiography. Chest 1975;67:239-241.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Echophonocardiographic Findings in a Patient With Aortic and Mitral Prostheses

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Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1981.00340060083018
Publisher site
See Article on Publisher Site

Abstract

Abstract A 33-year-old woman had undergone aortic and mitral valve replacement with Björk-Shiley prostheses in 1973 because of rheumatic valvular disease. She has been receiving digoxin and warfarin sodium since then. In November 1978, she noted the gradual onset of exertional dyspnea and orthopnea, which prompted her admission to the hospital. Physical examination disclosed a regular heart rate of 96 beats per minute, blood pressure of 120/70 mm Hg, and a grade 3/6 midsystolic murmur at the apex. A third sound of variable timing was noted. The ECG indicated left ventricular hypertrophy and left atrial enlargement only. A chest roentgenogram was compatible with congestive heart failure. Figure 1 is a simultaneous recording of the ECG, apical phonocardiogram (PCG), and mitral prosthetic valve echogram (PVE). What is your diagnosis? Diagnosis. —Malfunction of Björk-Shiley Mitral Prosthesis.Figure 2 is a higher paper-speed recording of the same graphics as in Fig 1. Note References 1. Bernal-Ramirez JA, Phillips JH: Echocardiographic study of malfunction of the Björk-Shiley prosthetic heart valve in the mitral position. Am J Cardiol 1977;40:449-453.Crossref 2. Clements SD, Perkins JV: Malfunction of a Björk-Shiley prosthetic heart valve in the mitral position producing an abnormal echocardiographic pattern. JCU 1978;6:334-336. 3. Felner JM, Schlant RC: Echocardiography: A Teaching Atlas. New York , Grune & Stratton Inc, 1976, pp 240-241. 4. Yuste P, Aza V, Minguez I, et al: Echocardiographic evaluation of mitral valve prosthesis malfunction , in Kazner E (ed): Ultrasonics in Medicine . Amsterdam, Excerpta Medica, 1975, pp 239-244. 5. Chun PC, Rajfer SI, Donohue DJ, et al: Björk-Shiley mitral valvular dehiscence documented by radiography, echocardiography, fluoroscopy, and cineangiography. Am Heart J 1980;99:230-234.Crossref 6. Carliner NH, Plotnick GD, Vassar DL, et al: Misleading noninvasive signs of Björk-Shiley mitral valve dysfunction. Johns Hopkins Med J 1978;143:160-162. 7. Busch UW, Mathur VS, Garcia E, et al: Echocardiography and prosthetic valve malfunction. Am J Cardiol 1978;42:690.Crossref 8. Jacovella G, Giampaolo P, Gambelli G, et al: Echocardiographic patterns of prosthetic valve malfunction. Am J Cardiol 1978;42:876.Crossref 9. Hildner FJ: Detection of prosthetic valve dysfunction by bedside and laboratory evaluation. Cardiovasc Clin 1973;5:289-306. 10. Gibson TC, Starek PJK, Moos S, et al: Echocardiographic and phonocardiographic characteristics of the Lillebei-Kester mitral valve prosthesis. Circulation 1974;49:434-440.Crossref 11. Zitnik RS, Burchell HB: A phonocardiographic study of patients with total prosthetic mitral valve replacement. Dis Chest 1963;44:11-17.Crossref 12. Berndt TB, Goodman DT, Popp RL: Echocardiographic and phonocardiographic confirmation of suspected caged mitral valve malfunction. Chest 1976;70:221-230.Crossref 13. Miller HC, Gibson DG, Stephens JD: Role of echocardiography and phonocardiography in diagnosis of mitral paraprosthetic regurgitation with Starr-Edwards prosthesis. Br Heart J 1973;35:1217-1225.Crossref 14. Brodie BR, Grossman W, McLaurin L, et al: Diagnosis of prosthetic mitral valve malfunction with combined echophonocardiography. Circulation 1976;53:93-100.Crossref 15. Schluger J, Mannix EP, Wolf RE: Auscultatory and phonocardiographic sign of ball variance in a mitral prosthetic valve. Am Heart J 1971;81:809-816.Crossref 16. Pfeifer J, Goldschlager N, Sweatman T, et al: Malfunction of mitral ball valve prosthesis due to thrombus. Am J Cardiol 1972;29:95-99.Crossref 17. Belenkie I, Carr M, Schlant RC, et al: Malfunction of a Cutter-Smeloff mitral ball valve prosthesis: Diagnosis by phonocardiography and echocardiography. Am Heart J 1973;86:399-403.Crossref 18. Kawai N, Segal BL, Linhart JH: Delayed opening of Beall mitral prosthetic valve detected by echocardiography. Chest 1975;67:239-241.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1981

References