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Dual valve replacement with flow murmur

This recording (taken at the lower left sternal edge with the diaphragm, in the upright position) aims to point out the mechanical nature of both the S1 and S2 in this patient (lacking the crisp metallic chink as these are well-aged prostheses) and the systolic flow murmur. A flow murmur tends to be soft (Grade 3 and below), does not radiate and is only localised to the region corresponding to the valve concerned - mitral for MVR, aortic or LLSE for AVR), and does NOT change with respiration unlike pathological/recurrent valvular pathologies (a paravalvular leak/paraprosthetic leak will imitate the pathological lesion for which the surgery was done - for example, a para-prosthetic leak for MVR done for MR will produce a similar systolic murmur best heard in the apex which is accentuated by expiration). In this case, the 'flow murmur' remains the same throughout the entire recording regardless of inspiration or expiration, and the patient is not in failure, valvular thrombosis or showing signs of infective endocarditis.