Non-invasive assessment of prosthetic mitral paravalvular and intravalvular regurgitation.

The ability of certain non-invasive recording techniques to diagnose mitral paravalvular regurgitation and intravalvular regurgitation has been assessed. The data obtained from the 30 patients studied suggest that while the recognition of severe mitral paravalvular regurgitation is usually possible using phonocardiography and carotid arterial pressure recordings, mild cases may be difficult to diagnose. The most useful non-invasive measurement in this study was a reduced aortic closure to mitral valve opening interval (A2-OCMV) which occurred in association with severe regurgitation in 3 of 4 patients (A2-OCMV< o'o8 second). With milder degrees consider- able overlap with patients with normally functioning mitral prostheses was present (2/3 with A2-OCMV: o0o8 second). A conspicuously reduced left ventricular ejection time (LVET) was seen in some patients but there was overlap with patients with normally functioning prostheses (ALVET> 70 msec in 5/Ir with mitral paravalvular regurgitation and in 3115 with normally functioning mitral prostheses). Reduced opening clicks were found in association with but were not specific for mitral paravalvular regurgitation or tissue ingrowth into the prosthesis and intra- valvular regurgitation. The presence or absence of systolic murmurs was misleading, and in the patients studied an unimpressive or absent apical systolic murmur in the presence of mitral paravalvular regurgitation suggested that it was severe.