Cineradiographic Evaluation of Prosthetic Cardiac Valves

Forty-nine patients whose clinical symptoms suggested a leaking cardiac prosthetic valve were studied by both cineradiography and angiocardiography. We found a wider range of tilting motion of the nonleaking mitral valve than has been previously shown. An angle of tilt greater than 6° for the prosthetic aortic valve strongly suggests separation of the prosthesis from its bed with a paravalvular leak, while the angle of tilt suggestive of a paravalvular leak for a prosthetic mitral valve is 12°. However, a tilt of less than these values does not entirely exclude the existence of a leak. We strongly suggest that routine cineradiography be done in each patient shortly after surgery, as a basis for comparison if the patient later develops a murmur or congestive heart failure.