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Aortic Ball Variance: Diagnosis and Treatment

JOHN C. HYLEN, M.D.; FRANK E. KLOSTER, M.D.; ALBERT STARR, M.D.; and HERBERT E. GRISWOLD, M.D.
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Presented in part November 12, 1969, at the Laennec Society and Forty-Second Scientific Sessions, the American Heart Association, Dallas, Tex.

▸Requests for reprints should be addressed to John C. Hylen, M.D., 3181 S. W. Sam Jackson Park Rd., Portland, Ore. 97201


Portland, Oregon


Ann Intern Med. 1970;72(1):1-8. doi:10.7326/0003-4819-72-1-1
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Increased incidences of acute valvular malfunction and of death due to changes in the silicone poppet of cardiac valve prostheses have been noted. Of the 47 long-term survivors of aortic replacement with the model 1000 series Starr-Edwards valve operated upon in a 1-year period beginning July 1, 1963, 40 patients have been available for follow-up. Of these, ball variance has been demonstrated by autopsy or reoperation in 30 (75%). Ball variance was noted at autopsy in 7 cases (18%) and was considered the cause of death in 5 (13%). The symptoms of ball variance are nonspecific and include fatigue, dyspnea on exertion, palpitation, dizzy spells, angina, and syncopal episodes. The diagnosis of aortic ball variance is based on the absence of the aortic opening sound; a consistently abnormal phonocardiogram or sound spectrogram, or both; recurrent embolic episodes; and late onset of aortic regurgitation or radiographic evidence of an abnormal barium-impregnated poppet, or both. Ball variance in the mitral prosthesis is also discussed.

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