Page 139 - Clinical Pearls in Cardiology

Valvular Heart Diseases 127

37. What are the auscultatory signs elicited in a patient
with a prosthetic heart valve?
There are mainly five types of prosthetic heart valves.
Modern mechanical valves like the St. Jude valve make
softer opening and closing sounds than the older ball
and cage mechanical valves like the Starr-Edwards valve.
The important auscultatory findings associated with the
major prosthetic valves are the following (Table 9):

Table 9: Findings associated with major prosthetic valves
Type of valve Mitral area Aortic area
Mechanical valves
Ball and cage Sharp opening sound Sharp aortic
valve after S2 opening sound
(Starr-Edwards) Sharp closing sound Systolic ejection
at S1 murmur
Systolic ejection Early diastolic
murmur murmur in case of
paravalvular leak
Disc valve Sharp closing sound Sharp closing
(Bjork-Shiley) at S1 sound at S2
Systolic ejection Systolic ejection
murmur murmur
Diastolic rumble
Bileaflet disc Sharp closing sound Soft opening
valve at S1 sound and sharp
(St. Jude) Soft systolic ejection closing sound
murmur Soft systolic
ejection murmur
Bioprosthetic valves
Xenograft valves Usually normal heart sounds
(porcine or Occasional soft systolic ejection murmur
bovine)
Homograft valves Usually normal heart sounds
(human) Occasional soft systolic ejection murmur