Double opening sound related to dysfunction in a caged disc mitral valve prosthesis

A grooved embolic fragment was removed from the femoral artery of a patient with a Kay-Shiley caged disc mitral valve prosthesis. An extra opening click that had been present before embolization disappeared coincidentally. This study demonstrates (1) the importance of establishing an expected range of normal systolic time intervals for a given prosthetic heart valve configuration, (2) the value of postoperative phonocardiograms in documenting the presence of an unexpected extra sound, and (3) the need for careful examination of embolic fragments recovered from patients with valve prostheses.