From the Guidelines
It is normal to hear a murmur or clicking sound after a metallic aortic valve replacement, which is a result of the valve's mechanical function. This sound, often described as a mechanical click or a ticking sound, is the normal functioning of the metallic valve as its leaflets open and close. Patients with mechanical valves typically have a grade 1-2/6 systolic ejection murmur at the base of the heart, along with the characteristic clicking sound. These sounds are expected findings during physical examination and generally indicate that the valve is working properly 1.
However, if you notice a significant change in the sound, such as a new or louder murmur, or if the clicking sound disappears, this could indicate a potential problem with the valve function such as obstruction, regurgitation, or thrombosis. In such cases, prompt medical evaluation is necessary. Regular follow-up with your cardiologist is important to monitor valve function through physical examination and periodic echocardiography, even when the valve sounds remain consistent. According to the guidelines, a complete baseline assessment should be performed 6–12 weeks after surgery, including clinical assessment, chest X-ray, ECG, TTE, and blood testing 1.
Some key points to consider after metallic aortic valve replacement include:
- Clinical assessment should be performed yearly—or as soon as possible if new cardiac symptoms occur 1
- TTE should be performed if any new symptoms occur after valve replacement or if complications are suspected 1
- Yearly echocardiographic examination is recommended after the fifth year in patients with a bioprosthesis and earlier in young patients 1
- Trans-prosthetic gradients are best interpreted in comparison with the baseline values, rather than in comparison with theoretical values for a given prosthesis, which lack reliability 1.
Overall, while a murmur or clicking sound after metallic aortic valve replacement is normal, any changes in these sounds should be promptly evaluated by a cardiologist to ensure proper valve function and prevent potential complications.
From the Research
Hearing Murmur After Metallic Aortic Valve Replacement
- The provided studies do not directly address the question of hearing a murmur after metallic aortic valve replacement.
- However, some studies discuss the assessment of paravalvular leak (PVL) after transcatheter aortic valve replacement using transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) 2.
- The presence of PVL can lead to a murmur, but the studies do not specifically mention the audibility of the murmur after metallic aortic valve replacement.
- One study discusses the use of TEE during transcatheter aortic valve implantation, including the assessment of PVL and its mechanism 3.
- Another study compares 3D TEE and multidetector computed tomography (MDCT) for pre-TAVR measurements, including annular area and diameter 4.
- While these studies provide information on the assessment and management of PVL and valve replacement, they do not directly answer the question of hearing a murmur after metallic aortic valve replacement.
- Therefore, based on the provided evidence, there is no clear answer to the question, and further research may be needed to address this specific topic 2, 5, 6, 3, 4.