Echo-phonocardiographic evaluation of obstruction of prosthetic mitral valve

Echo-phonocardiograms of 64 patients with multiple types of prosthetic mitral valves (PMV) were evaluated. Six patients demonstrated findings suggesting valve obstruction: four had surgical confirmation of prosthetic obstruction, one reduced cardiac output and pulmonary hypertension but no prosthetic dysfunction at surgery, and one is asymptomatic. Three of four patients with confirmed obstruction had variable second sound to opening click intervals (A₂-MO) with interrupted disc opening; two had interrupted disc closure with split closing clicks and three of four had surgical confirmation of prosthetic obstruction, one reduced cardiac output and pulmonary hypertension but no prosthetic dysfunction at surgery, and one is asymptomatic. Three of four patients with confirmed obstruction had variable second sound to opening click intervals (A₂-MO) with interrupted disc opening; two had interrupted disc closure with split closing clicks and three of four had reduced diastolic closure rate. In 58 clinically well patients with PMV, cycle-to-cycle A₂-MO varied little: 0-10 msec in sinus rhythm and 10-25 msec in atrial fibrillation. Diastolic closure rates of five different types of PMV were similar: 21.6 mm/sec, (rang 14-49). No patient had interrupted opening, closing or multiple closing clicks. Thus, delayed PMV opening or closure, altered A₂-MO interval and double closing clicks are highly useful in detecting patients with obstruction of a variety of mitral prostheses.