title: Phonocardiographic diagnosis of aortic ball variance.
abstract: Fatty infiltration causing changes in the silastic poppet of the Model 1000 series Starr-Edwards aortic valve prostheses (ball variance) has been detected with increasing 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.
authors.affiliation: Division of Cardiology, Department of Medicine, Division of Cardiopulmonary Surgery, Department of Surgery, University of Oregon Medical School, Portland, Oregon, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Hylen
authors.forename: F E
authors.initials: FE
authors.lastname: Kloster
authors.forename: R H
authors.initials: RH
authors.lastname: Herr
authors.forename: P Q
authors.initials: PQ
authors.lastname: Hull
authors.forename: A W
authors.initials: AW
authors.lastname: Ames
authors.forename: A
authors.initials: A
authors.lastname: Starr
authors.forename: H E
authors.initials: HE
authors.lastname: Griswold
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D004868:Equipment Failure; D005260:Female; D006347:Heart Sounds; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010701:Phonocardiography