© 2003 Fellowship of Postgraduate Medicine
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New murmurs in patients with prosthetic heart valves
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The differential diagnosis involves either valvular pathology or ventricular failure. Valvular pathology can be due to either valve dehiscence,1 valvular obstruction,1 or prosthetic valve endocarditis.2 Prosthetic valve endocarditis can be early or late. Early occurs less than 60 days after the primary operation and is usually due to resistant Staphylococcus epidermidis, Gram negative baccili, and fungi.2 Late prosthetic valve endocarditis is usually due to Streptococcus species.2
Potential causes of ventricular dysfunction include the initial valvular lesions, coronary artery disease, systemic or pulmonary hypertension, and coincident cardiomyopathy.2 The presence of new murmurs makes the diagnosis of ventricular failure much less likely.
Valve obstruction was confirmed during x-ray screening and echocardiography in both patients.
Pathological obstruction of prosthetic valves is due to either pannus or thrombosis of the valve. Pannus represents a fibrous overgrowth, which extends from the endocardium onto the prosthesis. While pannus is common on both biological and
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- New murmurs in patients with prosthetic heart valves
- N A Cromie, S J Walsh, A A M Ahmed, G Campalani
Postgrad. Med. J. 2003 79: 476.[Extract] [Full Text] [PDF]
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