[Diagnosis and outcome of dysfunction of mechanical prostheses of the heart valves (analysis of 143 cases)].

Diagnosis of dysfunction of heart valve prostheses has been reviewed in 143 patients over 17 years of follow-up. Sixty-eight paravalvular fistulas, 69 thromboses and 6 prosthetic ball or disk changes have been detected. Sepsis was the cause of prosthetic dysfunction in 61 (42.7%) patients. Diagnosis was difficult to make in cases of thrombosis in the area of the ventricular ring of the mitral prosthesis, thrombosis of the aortic prosthesis and ball changes. Because of similar phonocardiographic features, thrombosis of the obturative part of mitral prosthesis should be differentiated from thrombosis of the atrial part of the prosthesis and paravalvular fistula. The absence of diastolic murmur and prevailing symptoms of right ventricular insufficiency are distinctive features of obturator thrombosis rather than atrial thrombosis of the prosthesis. Thrombosis of the aortic prosthesis or a ball change should be suspected, if the ratio of the opening to closing tone amplitude drops below 0.5 and intermittent protodiastolic murmur emerges. Clinical phonocardiographic studies are capable of detecting prosthetic dysfunction in most cases.