Diastolic murmurs in the presence of Starr-Edwards mitral prosthesis
Insights
Diastolic murmurs with Starr-Edwards mitral prostheses, previously undescribed, were linked to clot obstruction or aortic insufficiency. This study clarifies Austin Flint murmur occurrences with prosthetic mitral valves.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Diastolic murmurs related to Starr-Edwards mitral prostheses are not well-documented.
- Understanding prosthetic valve sounds is crucial for patient management.
Purpose of the Study:
- To describe and analyze the causes of diastolic murmurs in patients with Starr-Edwards mitral prostheses.
- To investigate the mechanisms of Austin Flint murmurs in the context of prosthetic valves.
Main Methods:
- Case series analysis of five patients with Starr-Edwards mitral prostheses presenting with diastolic murmurs.
- Clinical auscultation, echocardiography, and prosthetic valve assessment.
Main Results:
- Three patients had murmurs due to prosthetic valve obstruction by clots.
- Two patients had murmurs associated with normally functioning prostheses and significant aortic insufficiency.
- The study identified specific conditions under which Austin Flint murmurs can occur with prosthetic mitral valves.
Conclusions:
- Diastolic murmurs in Starr-Edwards mitral prostheses can arise from clot obstruction or aortic insufficiency.
- The findings expand the understanding of Austin Flint murmurs, showing they can occur without traditional etiologies in prosthetic valve patients.
Abstract:
Diastolic murmurs associated with the Starr-Edwards mitral prosthesis have not been described previously. In this report, five patients with mitral prostheses are described in whom apical mid-diastolic and presystolic murmurs resulted from two different causes. Three patients had clots obstructing the prosthetic orifice. The other two had normally functioning protheses and moderately severe aortic insufficiency. The occurrence of mid-diastolic and presystolic murmurs in the presence of a normally functioning prosthetic mitral valve demonstrates that 1) the mid-diastolic Austin Flint murmur can occur in the absence of incomplete mitral valve opening, premature mitral valve closure, vibrating mitral leaflets, or relative mitral stenosis and 2) the presystolic Austin Flint murmur can occur in the absence of incomplete valve opening or presystolic mitral regurgitation. However, the presystolic murmur was associated with early closure movement of the presthetic poppet.
