Phonocardiographic Diagnosis of Aortic Ball

Fatty infiltration causing changes in the silastic poppet of the Model 1000 series Starr-Edwards aortic valve prostheses (ball variance) has been detected with increas-ing frequency and can result in sudden death. Phonocardiograms were recorded on 12 patients with ball variance confirmed by operation and of 31 controls. Ten of the 12 patients with ball variance were distinguished from the controls by an aortic opening sound (AO) less than half as intense as the aortic closure sound (AC) at the second right intercostal space (AO/AC ratio less than 0.5). Both AO and AC were decreased in two patients with ball variance, with the loss of the characteristic high frequency and amplitude of these sounds. The only patient having a diminished AO/AC ratio (0.42) without ball variance at reoperation had a clot extending over the aortic valve struts. The phonocardiographic findings have been the most reliable objective evidence of ball variance in patients with Starr-Edwards aortic prosthesis of the Model 1000 series. Additional Indexing Words: Silastic poppet Aortic opening sound to aortic closure sound ratio Starr-E-dwards aortic valve Aortic prosthetic valve IN November 1964, Krosnick ' observed the adjuvant to first case of death due to changes in the ball varianc silastic poppet of a Starr-Edwards aortic pros- in detail ai thesis. Pierie and associates2 in 1965 reported graphic find 16 additional cases of ball variance from wards aorti( among poppets that had been returned to the series (fig. 1 manufacturer. Most recently Herr and asso- For the pr ciates3 have recorded the clinical syndrome be defined associated with ball variance, emphasizing from physicc the risk of this abnormality and the impor- silastic pop tance of early recognition and treatment These alteral with reoperation. That preliminary report on the cag( noted phonocardiography to be an important creased dia: poppet, or ( the formatio