Left ventricular dysfunction versus paravalvular leak in patients with mitral disc prostheses. 
Left ventricular dysfunction and prosthesis malfunction are the main causes of hemodynamic deterioration following prosthetic mitral valve replacement.  The aim of this study is to reassess the usefulness of a combined echo-phonocardiographic technique to differentiate these different situations in order to select medical or surgical treatment in patients with a mitral disc prosthesis.  Two patient groups were studied.  The first group consists of five patients with paravalvular leak (PL), surgically or pathologically verified.  Second group: nine patients with left ventricular failure (LVF) and normal functioning prosthesis.  The diastolic diameter of the left ventricle (LV) was significantly increased in the LVF group compared with the PL group.  A protodiastolic hump was present in four cases of PL.  The variability of the interval between A2 and the mitral valve opening (delta A2-MVO) was less than 30 msec in the LVF group and greater than 30 msec in the PL group.  The interval between A2 and maximal LV posterior wall (A2-PW) exceeded 60 msec in the PL group and was shorter than 60 msec in the LVF group.  the echo-phonocardiographic technique, especially when by using two newly proposed parameters, seems to be very useful to discriminate between PL and LVF.