Change in Character of Mitral Prosthesis Regurgitant Murmur With Bundle-Branch Block
Correlation of Auscultatory and Echocardiographic Findings
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.
- Copyright © 2001 by American Heart Association