Clinical significance of multiple systolic clicks from Starr-Edwards prosthetic aortic valves.

The use of echocardiography, phonocardiography, and spectroanalysis has enhanced the ability to detect prosthetic valve dysfunction even before the onset of symptoms in many patients. Reduction in the intensity of the opening and closing clicks and the appearance of new murmurs have been the most frequently reported observations in predicting prosthetic valve dysfunction. Simultaneous echocardiography, phonocardiography, and spectroanalysis were performed on 31 patients with Starr-Edwards prosthetic aortic valves. Eighteen patients had valves with metal (titanium or 'stellite') poppets, and 13 had valves with non-metal (silastic) poppets. In all patients with normally functioning valves with metal poppets, there were multiple systolic clicks on auscultation and confirmed by phonocardiography and spectroanalysis. In none of the patients with non-metal poppets were there clicks other than those associated with the normal opening and closing move-