1. Occasional Single Beat Regurgitation Observed with the Medtronic Advantage Bileaflet Heart Valve 
Walter B. Eichinger, MD, PhD, Ina M. Wagner, MD, Sabine Bleiziffer, MD, Friederike von Canal, MD, Ralf Günzinger, MD, Daniel J. Ruzicka, MD, Ulrich Busch, MD, PhD, Robert Bauernschmitt, MD, PhD, Ruediger Lange, MD, PhD 
The Annals of Thoracic Surgery 
Volume 82, Issue 2, Pages (August 2006)
DOI: /j.athoracsur
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(A) Distribution of orientation of the valve leaflets in all patients. (B) Valve orientation in patients with intermittent regurgitation. (L.C. = left coronary; N.C. = noncoronary; R.C. = right coronary.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
(A) The expected leakage volume through the hinge region of an Advantage prosthesis is depicted as it can be seen in color flow imaging. (B) An intermittent trivial to moderate valve insufficiency is shown as it was detected in 5 patients during routine transthoracic echocardiography. (C) An M-mode recording of the left ventricular outflow tract and anterior mitral leaflet. The arrow indicates the intermittent regurgitation during diastole. (LV = left ventricle; LA = left atrium.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Digital phonocardiogram of 1 patient with an intermittent regurgitation. Beats 1, 2, and 4 show the normal closure sound of a bileaflet prosthesis. The two peaks represent the closure sound of the two leaflets. After beat 3, an intermittent regurgitation was echocardiographically detected. The closure sound of one leaflet is missing in beat 3.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
(A) While one leaflet is completely closed, the second leaflet stays in a slightly open position during the whole diastole (white arrow, top). The housing and leaflet edges are radiolucent and cannot be visualized with this technique. It should be noted that the housing extends above and below the titanium insert ring. (B) Injection of contrast fluid into the aortic root shows the regurgitant jet (white arrow, bottom) (same patient as in Fig 4A.) This time the other leaflet did not close completely. Angiographically, the severity of the regurgitation was graded as II+ to III+.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Invasive blood pressure measurement in a patient with intermittent regurgitation. The arrow indicates the diastolic pressure drop that clearly could be associated with each pathologic leaflet motion of the prosthesis.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions