Misleading supine chest X-ray in complete detachment of a Starr-Edwards prosthetic aortic valve.

The authors report a case of total detachment of a Starr-Edwards aortic valve prosthesis occurring eleven years after implantation. The detached valve had embolized into the descending thoracic aorta. The prosthetic valve was projected into an apparently normal position on a supine chest X-ray. The correct diagnosis was thus delayed. The authors stress the importance of obtaining lateral views or performing fluoroscopy and/or echocardiography in the emergency room in patients with acute chest symptoms after heart valve replacement.