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Determining the Specific Etiology of a New Mitral Bioprosthetic Murmur Using Echo‐Phonocardiography

Determining the Specific Etiology of a New Mitral Bioprosthetic Murmur Using Echo‐Phonocardiography Jonathan F. Plehn, MD, and Philip R. Liebson, MD The onset of a loud apical systolic murmur is highly suggestive of valvular incompetence in a patient with a bioprosthetic mitral valve. This may be caused by a transvalvular or perivalvular leak. We recently were able to establish the specific cause of such a murmur through the use of m-mode echo-phonocardiography. CASE REPORT A 50-year-old white woman complained of progressive dyspnea on exertion, pedal edema, and a new “honking” sound in her chest. She had received a porcine bioprosthetic mitral valve replacement for severe mitral stenosis 3% years previously. She had been asymptomatic since that time. On physical examination, the patient was a slightly cachectic woman in no apparent distress. Her neck veins were engorged to the level of the mandible and bilateral basilar rales were appreciated. The point of maximal cardiac impulse was at the sixth intercostal space, 2 cm medial to the anterior axillary line and an apical thrill was easily palpable. There was a changing irregular rhythm, a decreased S1,and S2 was obscured by a grade six holosystolic honking murmur heard best at the apex but radiating across the precordium to the axilla. The patient also http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Ultrasound Wiley

Determining the Specific Etiology of a New Mitral Bioprosthetic Murmur Using Echo‐Phonocardiography

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References (5)

Publisher
Wiley
Copyright
Copyright © 1984 Wiley Periodicals, Inc., A Wiley Company
ISSN
0091-2751
eISSN
1097-0096
DOI
10.1002/jcu.1870120210
Publisher site
See Article on Publisher Site

Abstract

Jonathan F. Plehn, MD, and Philip R. Liebson, MD The onset of a loud apical systolic murmur is highly suggestive of valvular incompetence in a patient with a bioprosthetic mitral valve. This may be caused by a transvalvular or perivalvular leak. We recently were able to establish the specific cause of such a murmur through the use of m-mode echo-phonocardiography. CASE REPORT A 50-year-old white woman complained of progressive dyspnea on exertion, pedal edema, and a new “honking” sound in her chest. She had received a porcine bioprosthetic mitral valve replacement for severe mitral stenosis 3% years previously. She had been asymptomatic since that time. On physical examination, the patient was a slightly cachectic woman in no apparent distress. Her neck veins were engorged to the level of the mandible and bilateral basilar rales were appreciated. The point of maximal cardiac impulse was at the sixth intercostal space, 2 cm medial to the anterior axillary line and an apical thrill was easily palpable. There was a changing irregular rhythm, a decreased S1,and S2 was obscured by a grade six holosystolic honking murmur heard best at the apex but radiating across the precordium to the axilla. The patient also

Journal

Journal of Clinical UltrasoundWiley

Published: Feb 1, 1984

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