Clinical evaluation of aortic and mitral valve prostheses

The clinical follow-up for a large number of patients with aortic and mitral valve prostheses is now the responsibility of the general internist and cardiologist, particularly those physicians who recommended operation. Proper follow-up of patients with prosthetic heart valves can be performed only if the physician is aware of the "natural history" of the patient following valve replacement as well as of the common complications associated with cardiac valve prostheses. This article discusses the hemodynamic changes which follow cardiac valve replacement, complications associated with valve replacement (congestive heart failure, suture disruption, "ball variance," thromboembolism, hemolysis, cardiomyopathy, etc.) and simple clinical means of detecting these complications. Some special techniques which may be useful in diagnosing complications of prosthetic cardiac valve malfunction are described. It is emphasized that the physician should not consider the patient "cured" once he has undergone cardiac valve replacement, but rather should consider him to be the subject of meticulous long-term medical care.