Starr-Edwards Prosthetic Valve

  • The old “ball-in-cage” prosthetic valve was designed by Albert Starr and Lowell Edwards and implanted into a patient for the first time in 1960.
  • The design of the prosthetic valve is unique in that increased pressure either forces the ball to descend to the base of the cage (“closed” position) or ascend inside the cage, exposing the hollow walls of the cage and allowing for blood to flow through (“open”) position.
  • When blood flows through the valve it causes the ball to “rattle” at the top of the cage, creating a unique sound.
  • The Starr-Edwards “rattle” is listed in the category of continuous sounds, but in reality it is made up of several transient sounds.
 

Patient 1:

This is an older woman with a history of rheumatic heart disease status-post aortic valve replacement with a Starr-Edwards caged-ball prosthetic valve. Note the distinctive “ejection rattle”.

This patient also has elevated jugular venous pulse to the temple.

Starr-Edwards

Annotated

Starr-Edwards

Annotated

Patient 2:

This patient has a Starr-Edwards prosthetic valve in the mitral position. Notice that the opening sound (“rattle”) is close to S2, in contrast to the Starr-Edwards valve in the aortic position where the “rattle” occurs near S1.

Starr-Edwards

Annotated