This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ryan, E. W. Articles by Foster, E. Search for Related Content PubMed PubMed Citation Articles by Ryan, E. W. Articles by Foster, E. Related Collections Valvular heart disease Echocardiography CV surgery: valvular disease

(Circulation. 2001;103:1715.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Change in Character of Mitral Prosthesis Regurgitant Murmur With Bundle-Branch Block

Correlation of Auscultatory and Echocardiographic Findings

Elizabeth W. Ryan, MBBS; Elyse Foster, MD

From the University California, San Francisco.

Correspondence to Elyse Foster, MD, FACC, Director, Adult Echocardiography Laboratory, University of California, San Francisco, 505 Parnassus Ave, M314, San Francisco, CA 94143-0214. E-mail foster@medicine.ucsf.edu (Circulation. 2001;103:1715-1716.)

Key Words: mitral valve regurgitation echocardiography prosthesis murmur

This 75-year-old woman, in whom a Carpentier Edwards porcine mitral valve prosthesis (No. 29) had been implanted in 1990, presented with episodic breathlessness and dizziness. Examination revealed an apical pansystolic murmur with a frequent but intermittent loud musical "honking" character. The patient was in sinus rhythm, 68 to 74 bpm, with alternating runs of narrow QRS and bundle-branch block. The amplified, honking quality was observed intermittently only during periods of narrow QRS complexes.

Echocardiography revealed thickened prosthesis leaflets, a 3-mm vibrating density (Figure 1) on the leaflet’s atrial surface, and a 2-mm systolic coaptation defect with prosthesis regurgitation. The regurgitant jet was eccentric, directed anteriorly and toward the left atrial appendage. Regurgitation was graded as moderate. Mitral inflow velocities were mildly elevated (peak E 1.3 m/s, peak A 1.8 m/s, and mean gradient 6.6 mm Hg), with a pressure half-time of 123 ms, indicative of minimal prosthesis stenosis. Systolic vibration is noted on M-mode echocardiography of the mitral prosthesis (Figure 2) associated with marked aliasing of color (Figures 3 and 4) corresponding to the honking murmur. Increased density of the continuous-wave spectral Doppler (Figure 4) is also noted in conjunction with the intermittent honking murmur.

View larger version (127K): [in this window] [in a new window]   Figure 1. Transesophageal image of porcine mitral prosthesis. Arrow indicates a vibratory mass on atrial side of prosthesis. LA indicates left atrium; LV, left ventricle.

View larger version (81K): [in this window] [in a new window]   Figure 2. Transthoracic M-mode recording of mitral prosthesis. Arrows indicate systolic vibration of leaflets. LA indicates left atrium; MV, mitral valve prosthesis leaflets.

View larger version (43K): [in this window] [in a new window]   Figure 3. Transthoracic parasternal views showing mitral prosthesis regurgitation. . . . [Full Text of this Article]