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Normal auscultatory findings of prosthetic valves according to type and location

Normal auscultatory findings of prosthetic valves according to type and location
Valve prosthesis Auscultatory Findings
Mitral Aortic
Ball valves (eg, Starr-Edwards)   A2-MO interval 0.07 to 0.11 seconds S1-AO interval 0.07 seconds
MO louder than MC AO louder than AC
Soft systolic murmur Soft, harsh systolic ejection murmur
No diastolic murmur "Seating puff" - diastolic rumble
Tilting disc valves (eg, Medtronic-Hall)  A2-MO interval 0.05 to 0.09 second S1-AO interval 0.04 seconds
MO is soft or may not be audible AC louder than AO
Soft systolic murmur Soft systolic ejection murmur
Soft and short diastolic rumble "Seating puff" - diastolic rumble
Bioprosthetic valves A2-MO interval 0.1 seconds S1-AO interval 0.03 to 0.08 seconds
MC louder than MO AC louder than AO
MO is audible in approximately 50% AO may be absent
Soft apical systolic murmur Soft systolic ejection murmur
Soft diastolic ramble No diastolic rumble
Bileaflet valves (eg, St. Jude)   Loud AO and AC 
  Soft systolic ejection murmur
A2: aortic valve closure sound; MO: mitral prosthesis opening sound; MC: mitral prosthesis closing sound; S1: first heart sound; AO: aortic prosthesis opening sound; AC: aortic prosthesis closing sound.
Data from Smith ND, Ralzada V, Abrams J: Auscultation of the normally functioning prosthetic valve. Ann Intern Med 95:594, 1981.
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