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New murmurs in patients with prosthetic heart valves

¹ Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland
² Department of Cardiac Surgery, Royal Victoria Hospital, Belfast, Northern Ireland

Correspondence to:
Correspondence to:
Dr Nicholas A Cromie, Royal Victoria Hospital, Belfast BT12 6BA, UK;
cardiac.research@royalhospitals.n-i.nhs.uk

Submitted 11 November 2002
Accepted 31 December 2002

Keywords: peripheral neuropathy; sarcoidosis; diabetes

The first 150 words of the full text of this article appear below.

Case 1
A 58 year old woman with previous replacement of a bicuspid aortic valve (size 23 St Jude Medical prosthesis) in 1994 for aortic stenosis, presented with a three week history of increasing shortness of breath. During this time she had stopped her diuretic as she had suffered an acute exacerbation of gout. On initial assessment, an ejection systolic murmur and early diastolic murmur were noted. The patient was found to be in moderate left heart failure (Killip class II). Echocardiography demonstrated a peak systolic velocity of 4.7 m/sec across the aortic valve (peak gradient of 85 mm Hg). There was moderate aortic regurgitation and it appeared that the prosthesis was malfunctioning. There was no evidence of endocarditis and the patient’s international normalised ratio was therapeutic at 2.1. Radiographic valve screening was performed and the appearances are demonstrated in fig 1.

View larger version (137K): [in this window] [in a new window]   Figure 1 Valve screening. (A) Left anterior oblique view in . . . [Full text of this article]