Twenty-six months after implantation of an 8 AT Starr-Edwards prosthetic aortic valve, anemia developed in a 40-year-old woman. Four embolic episodes occurred the following month, despite adequate anticoagulation therapy. There was no evidence of the other two abnormalities due to ball variance, namely, diastolic murmur due to valve incompetence or electrocardiographic changes of ischemia. Five fissures harboring thrombi, and irregularity and color changes were observed in the ball at exploratory operation, and the ball was replaced. The high coincidence of ball variance with small sizes of prosthetic aortic valves demands a program of regular, frequent follow-up examinations of patients with those prostheses to detect abnormalities early. Surgical exploration appears mandatory for embolic complications, and relative for anemia, valve incompetence, and electromechanical abnormalities affecting the myocardium.
Scalabrini BY, Rader B, Milano A, Clauss RH. Successful Replacement of Defective Ball of a Prosthetic Aortic Valve. JAMA. 1968;203(5):333–336. doi:10.1001/jama.1968.03140050017004
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