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Radiographic Diagnosis of Aortic-Ball Variance FREE

John C. Hylen, MD; Melvin P. Judkins, MD; Rodney H. Herr, MD; Albert Starr, MD
[+] Author Affiliations

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JAMA. 1969;207(6):1120-1122. doi:10.1001/jama.1969.03150190042008
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Assessing changes in the silicone-rubber ball of the Model 1000 series Starr-Edwards aortic-valve prosthesis is an increasingly frequent diagnostic problem. Bariumimpregnated, silicone-rubber balls have been available since 1962. Presently, these constitute slightly less than 10% of all silicon-rubber balls distributed. Radiographic evidence of aortic-ball variance was obtained for a patient having normal sounds of the prosthetic aortic valve as determined by auscultation, phonocardiography, and sound spectrography. All silicone-rubber balls now produced by the manufacturer are barium-impregnated; henceforth, radiographic techniques will be more uniformly applicable to the early diagnosis of aortic-ball variance. Since most patients with aortic-ball variance are asymptomatic, routine screening for the early detection of ball variance is suggested for all patients with barium-impregnated, silicone-rubber balls. Serial high-resolution films and cineradiography should be used.

REFERENCES

Starr, A., et al:  Cardiac Valve Replacement: Experience With Durability of Silicone Rubber , Circulation 33 ( (suppl 1) ): 115-123 (April) 1966;.
Herr, R.H., et al:  Diagnosis and Management of "Ball Variance" Following Aortic Valve Replacement , Circulation 36 ( (suppl 2) ): 141 (Oct) 1967;.
Hylen, J.C., et al:  Phonocardiographic Diagnosis of Aortic Ball Variance , Circulation 38:90-102 ( (July) ) 1968;.
Hylen, J.C., et al:  Sound Spectrographic Diagnosis of Aortic Ball Variance , Circulation ( (suppl 6) ): 105 (Oct) 1968;.
Herr, R.H., et al:  Aortic Valve Replacement: A Review of Six Years Experience With Ball Valve Prosthesis , Ann Thorac Surg 6:199-218 ( (Sept) ) 1968;.
Krosnick, A.:  Death Due to Migration of the Ball From an Aortic-Valve Prosthesis , JAMA 191:1083-1084 ( (March 29) ) 1965;.
Ablaza, S.G.G., et al:  Fatal Extrusion of the Ball From a Starr-Edwards Aortic Valve Prosthesis: Report of a Case , J Thorac Cardiovasc Surg 50:401-409 ( (Sept) ) 1965;.
Laforet, E.G.:  Death Due to Swelling of Ball Component of Aortic Ball-Valve Prosthesis , New Eng J Med 276:1025-1027 ( (May 4) ) 1967;.
Allen, P., and Robertson, R.:  The Significance of Intermittent Regurgitation in Aortic Valve Prostheses , J Thorac Cardiovasc Surg 54:549-552 ( (Oct) ) 1967;.
Newman, M.M.; Hoffman, M.S.; and Gesink, M.H.:  Mechanical Failure of Starr-Edwards Aortic Prosthesis Due to Ball Fracture , J Thorac Cardiovasc Surg 53:398-400 ( (March) ) 1967;.
Scalabrini, B.Y., et al:  Successful Replacement of Defective Ball of a Prosthetic Aortic Valve , JAMA 203:333-336 ( (Jan 29) ) 1968;.
Cohen, M.; Barwinsky, J.; and Mymin, D.:  Late Failure of the Ball-Valve (Starr) Aortic Prosthesis , Canad J Surg 11:144-150 ( (April) ) 1968;.
Bonnabeau, R.C., and Lillehei, C.W.:  Mechanical "Ball Failure" in Starr-Edwards Prosthetic Valves: A Report of Three Cases , J Thorac Cardiovasc Surg 56:258-264 ( (Aug) ) 1968;.
Garcia, M.C., et al:  Hemolytic Anemia Due to Progressive Enlargement of Silastic Ball Component of Aortic Prosthesis , Circulation 38:505-513 ( (Sept) ) 1968;.
Herr, R.H., et al:  Special Problems Following Valve Replacement: Embolus, Leak, Infection, and Red Cell Damage , Ann Thorac Surg 1:403-415 ( (July) ) 1965;.
Starr, A., et al:  Aortic Replacement: Clinical Experience With a Semirigid Ball-Valve Prosthesis , Circulation 27:779-783 ( (April) ) 1963;.
Judkins, M.P.:  Percutaneous Transfemoral Selective Coronary Arteriography , Radiol Clin N Amer , to be published.
Dayem, M.K.A., and Raftery, E.B.:  Phonocardiograms of the Ball-and-Cage Aortic Valve Prosthesis , Brit Heart J 29: 446-451 ( (Aug) ) 1966;.

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Starr, A., et al:  Cardiac Valve Replacement: Experience With Durability of Silicone Rubber , Circulation 33 ( (suppl 1) ): 115-123 (April) 1966;.
Herr, R.H., et al:  Diagnosis and Management of "Ball Variance" Following Aortic Valve Replacement , Circulation 36 ( (suppl 2) ): 141 (Oct) 1967;.
Hylen, J.C., et al:  Phonocardiographic Diagnosis of Aortic Ball Variance , Circulation 38:90-102 ( (July) ) 1968;.
Hylen, J.C., et al:  Sound Spectrographic Diagnosis of Aortic Ball Variance , Circulation ( (suppl 6) ): 105 (Oct) 1968;.
Herr, R.H., et al:  Aortic Valve Replacement: A Review of Six Years Experience With Ball Valve Prosthesis , Ann Thorac Surg 6:199-218 ( (Sept) ) 1968;.
Krosnick, A.:  Death Due to Migration of the Ball From an Aortic-Valve Prosthesis , JAMA 191:1083-1084 ( (March 29) ) 1965;.
Ablaza, S.G.G., et al:  Fatal Extrusion of the Ball From a Starr-Edwards Aortic Valve Prosthesis: Report of a Case , J Thorac Cardiovasc Surg 50:401-409 ( (Sept) ) 1965;.
Laforet, E.G.:  Death Due to Swelling of Ball Component of Aortic Ball-Valve Prosthesis , New Eng J Med 276:1025-1027 ( (May 4) ) 1967;.
Allen, P., and Robertson, R.:  The Significance of Intermittent Regurgitation in Aortic Valve Prostheses , J Thorac Cardiovasc Surg 54:549-552 ( (Oct) ) 1967;.
Newman, M.M.; Hoffman, M.S.; and Gesink, M.H.:  Mechanical Failure of Starr-Edwards Aortic Prosthesis Due to Ball Fracture , J Thorac Cardiovasc Surg 53:398-400 ( (March) ) 1967;.
Scalabrini, B.Y., et al:  Successful Replacement of Defective Ball of a Prosthetic Aortic Valve , JAMA 203:333-336 ( (Jan 29) ) 1968;.
Cohen, M.; Barwinsky, J.; and Mymin, D.:  Late Failure of the Ball-Valve (Starr) Aortic Prosthesis , Canad J Surg 11:144-150 ( (April) ) 1968;.
Bonnabeau, R.C., and Lillehei, C.W.:  Mechanical "Ball Failure" in Starr-Edwards Prosthetic Valves: A Report of Three Cases , J Thorac Cardiovasc Surg 56:258-264 ( (Aug) ) 1968;.
Garcia, M.C., et al:  Hemolytic Anemia Due to Progressive Enlargement of Silastic Ball Component of Aortic Prosthesis , Circulation 38:505-513 ( (Sept) ) 1968;.
Herr, R.H., et al:  Special Problems Following Valve Replacement: Embolus, Leak, Infection, and Red Cell Damage , Ann Thorac Surg 1:403-415 ( (July) ) 1965;.
Starr, A., et al:  Aortic Replacement: Clinical Experience With a Semirigid Ball-Valve Prosthesis , Circulation 27:779-783 ( (April) ) 1963;.
Judkins, M.P.:  Percutaneous Transfemoral Selective Coronary Arteriography , Radiol Clin N Amer , to be published.
Dayem, M.K.A., and Raftery, E.B.:  Phonocardiograms of the Ball-and-Cage Aortic Valve Prosthesis , Brit Heart J 29: 446-451 ( (Aug) ) 1966;.
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