title: Assessment of perceived mechanical heart valve sound level in patients.
abstract: OBJECTIVE
  When mechanical heart valves close, they generate an impulse that is transmitted to the patient's inner ear by two routes: (i) As acoustically transmitted sound waves; and (ii) as vibrations transmitted through bones and vessels. The aim of this study was to quantitate what patients perceive as sound from their mechanical heart valve prostheses - including both air-transmitted sound waves and bone-transmitted vibrations.
  
  
  METHODS
  Thirty-four patients with implanted mechanical bileaflet aortic and mitral valves (St. Jude Medical and On-X) were included in the study. Measurements were performed in a specially designed sound-insulated chamber equipped with microphones, accelerometers, preamplifiers and a loud-speaker. The closing sounds measured by an accelerometer on the patient's chest were delayed 400 ms, amplified and played back to the patient through the loudspeaker. The patient adjusted the feedback sound to the same level as the 'real-time' clicks they perceived directly from their valve. In this way the feedback sound energy includes both the air- and bone-transmitted energies. Sound pressure levels (SPL) were quantitated in both dB(A) and in loudness units (sones) according to ISO 532B (Zwicker method).
  
  
  RESULTS
  The mean air-transmitted SPL measured close to the patient's ear was 23 +/- 4 dB(A). The total air-and bone-transmitted sounds and vibrations were perceived by the patients as a SPL of 34 +/- 5 dB(A). There was no statistically significant difference in perceived sound from the two bileaflet valves investigated, and no difference between aortic and mitral valves.
  
  
  CONCLUSIONS
  The study showed that the presented feedback method is capable of quantitating the perceived sounds and vibrations from mechanical heart valves, if the patient's hearing is not too impaired. Patients with implanted mechanical heart valve prostheses seem to perceive the sound from their valve two to four times higher than nearby persons, because of the additional bone-transmitted vibrations.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby Sygehus, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Nygaard
authors.forename: P
authors.initials: P
authors.lastname: Johansen
authors.forename: C
authors.initials: C
authors.lastname: Riis
authors.forename: J M
authors.initials: JM
authors.lastname: Hasenkam
authors.forename: P K
authors.initials: PK
authors.lastname: Paulsen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001021:Aortic Valve; D001299:Audiometry / Q000379:methods; D005260:Female; D006347:Heart Sounds; D006350:Heart Valve Prosthesis / Q000523:psychology; D006801:Humans; D008144:Loudness Perception; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve