Onset of new diastolic murmur as a sign of bioprosthetic valve dysfunction: A case report

The diagnosis of prosthetic valve dysfunction remains challenging because visualization is limited due to artifacts on echocardiography. We herein report a case of bioprosthetic valve dysfunction, in which cardiac auscultation was useful as an initial clue to the diagnosis. An 81-year-old man, who had undergone bioprosthetic aortic valve replacement due to aortic stenosis 10 years earlier, presented to the emergency department with chest discomfort. Cardiac auscultation revealed a newly developed diastolic murmur, although no diastolic murmurs were previously detected on auscultation or phonocardiography. There were no notable changes in electrocardiography, chest radiograph, laboratory tests, or echocardiography except for trivial aortic regurgitation. His hemodynamic status progressively deteriorated due to prosthetic valve dysfunction, which was later confirmed on echocardiography, and aortic valve re-replacement was semi-urgently performed with success. The diastolic murmurs disappeared after surgery. <Learning objective: This case once again highlights the importance of cardiac auscultation for diagnosis even with the use of advanced imaging technology.>.