Delayed opening of Beall mitral prosthetic valve detected by echocardiography

A 47-year-old woman in normal sinus rhythm developed frequent pulse deficits, immediately following mitral valve replacement with a Beall disc prosthesis. Emergency bedside simultaneous tracing of echocardiogram, phonocardiogram and arterial pulse revealed a delayed opening of the disc with various timing intervals in diastole, and suggested some form of interference with normal disc motion. An interfering papillary muscle remnant was later confirmed and corrected by reoperation.