Phonocardiographic manifestations of heterograft valve dysfunction in the mitral area.

Phonocardiographic and pathological features of mitral porcine aortic heterograft valve failure are described in 1o patients with rheumatic valvular disease. Six had isolated mitralporcine aortic heterograft valve; 3 also had one in the aortic area; one had this in both mitral and tricuspid areas with an aortic ball valve prosthesis. Allpatients had systolic murmurs at the apex indicative of mitral insufficiency, 8 had prominent third heart sounds. Five had specific and unusual varia- tions in the systolic murmurs consisting of (i) conspicuous alternation of systolic murmur intensity with heart beat independent ofpreceding cycle length and/or (2) division of the systolic murmur into distinct components. Seven required reoperation with replacement of the mitral porcine aortic heterograft valve. Commissural separation from the stent was the major finding in 4; primary leaflet damage in 3. Only patients with commissural separationfrom the stent exhibited these two specific and unusual variations of the systolic murmur which thus appear to result from oscillation of the torn commissure. A systolic murmur consisting of several distinct components and/or varying intensity may therefore be presumptive evidence for commissural separationfrom the stent of the heterograft valve.