Clinical Features

Many patients have persistent dyspnea and reduced effort tolerance after successful valve replacement. This is more common in the presence of preexisting heart dysfunction or atrial fibrillation. Many symptoms of valvular dysfunction described in the preceding sections on specific valvular disease may occur in the setting of prosthetic valves. However, in addition to those symptoms, patients with prosthetic valves experience symptoms specific to the presence of the artificial valve.

Large paravalvular leaks usually present with congestive heart failure or hemolytic anemia. Patients with new neurologic symptoms may have thromboembolism associated with the valve thrombi or endocarditis. Minor embolic episodes, such as transient neurologic symptoms, amaurosis fugax, or self-limited ischemic episodes in the extremities or organs in the absence of endocarditis, are common. Patients may present with major embolic events, including stroke, mesenteric infarction, or sudden death. Major bleeding due to anticoagulant therapy can also occur, with hemorrhagic stroke the most common lethal bleeding complication.

Patients with prosthetic valves usually have abnormal cardiac sounds. Mechanical valves have loud, metallic closing sounds. Systolic murmurs are commonly present with mechanical models. Loud diastolic murmurs are generally not present with mechanical valves. Patients with bioprostheses usually have normal S and S2, with no abnormal opening sounds. The aortic bioprostheses is usually associated with a short midsystolic murmur. Only the mitral bioprostheses is normally associated with a diastolic rumble.

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