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Echophonocardiographic Findings in a Patient With Aortic and Mitral Prostheses

Peter J. Engel, MD; Herbert D. Long Jr, MD; David Eppert
Arch Intern Med. 1981;141(6):775-777. doi:10.1001/archinte.1981.00340060083018.
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A 33-year-old woman had undergone aortic and mitral valve replacement with Björk-Shiley prostheses in 1973 because of rheumatic valvular disease. She has been receiving digoxin and warfarin sodium since then. In November 1978, she noted the gradual onset of exertional dyspnea and orthopnea, which prompted her admission to the hospital. Physical examination disclosed a regular heart rate of 96 beats per minute, blood pressure of 120/70 mm Hg, and a grade 3/6 midsystolic murmur at the apex. A third sound of variable timing was noted. The ECG indicated left ventricular hypertrophy and left atrial enlargement only. A chest roentgenogram was compatible with congestive heart failure. Figure 1 is a simultaneous recording of the ECG, apical phonocardiogram (PCG), and mitral prosthetic valve echogram (PVE).

What is your diagnosis?

Diagnosis.  Malfunction of Björk-Shiley Mitral Prosthesis.Figure 2 is a higher paper-speed recording of the same graphics as in Fig 1. Note


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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