Silicone Ball Variance: A Clinical and Pulse Duplicator Study

Abstract

A 49-year-old Caucasian salesman had undergone aortic valve replacement with a Harken caged-ball valve prosthesis in May, 1964, because of aortic stenosis and insufficiency with symptoms of congestive heart failure. There was evidence of mild mitral insufficiency at the time of aortic valve replacement. Convalescence had been rapid and uneventful, and the patient returned to his job. A soft diastolic murmur was present along the left sternal border, and there was a soft systolic murmur at the apex as well. Anticoagulation therapy was discontinued five months after operation because of an episode of upper gastrointestinal bleeding. A diagnosis of duodenal ulcer was established by contrast roentgenography. Sudden chest pain four months later suggested the possibility of coronary artery embolus. Anticoagulation therapy with sodium warfarin was reinstituted. In January, 1967, the patient was awakened by a sudden attack of dyspnea. X-rays had consistently shown cardiac enlargement. Cardiac catheterization revealed a cardiac output of 4.6 liters with an index of 2.4 liters. The left ventricular pressure was 125/0, and the aortic pressure was 125/80. The right ventricular pressure was 50/0, and the pulmonary artery pres-