How to identify prosthetic valves on chest X-ray?

Often, we are faced with a patient with a valve prosthesis who is unable to provide further information about the device. Thus, chest X-rays will be an important ally in identifying prosthetic valves.

For this, we have a step by step to identify the position of valve prostheses:

PA X-ray: draw an imaginary line from the left atrial appendage to the right costophrenic angle.

Lateral X-ray: draw a line from the carina to the apex of the heart

See the figure below:

Some considerations:

• The pulmonary valve is always the highest

• The tricuspid valve is always the lowest

• The aortic valve is above the imaginary line and the mitral valve below

How to define whether it is biological or mechanical?

Look at the ring. There are several types of mechanical prosthesis, but all will have some content inside the ring. Biological ones do not have content inside the ring, only around it. Let's see some examples:

References:

1. Radiopaedia.org

2. Mathew RP, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Cardiovascular implantable electronic devices, cardiac valve prostheses and Amplatzer occluder devices. SA Journal of Radiology. 2019;23(1):1730. DOI: 10.4102/sajr.v23i1.1730. PMID: 31754536; PMCID: PMC6837806.

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