a) Prosthetic aortic valve
b) Prosthetic pulmonary valve
c) Prosthetic mitral valve
d) Prosthetic tricuspid valve
Answer: c) Prosthetic mitral valve
Prosthetic mitral valve – Starr Edward Prosthesis (SEP). Mitral position of the prosthesis is identified by the location below the line joining the left hilum and right cardiophrenic angle. The sewing ring is above and the cage pointing downwards. There are four struts for a mitral prosthesis while an aortic prosthesis has only three. The position of the aortic prosthesis will be above the reference line mentioned above and the cage will be pointing upwards. A double atrial shadow or ‘shadow in shadow’ indicating left atrial enlargement is seen along the right heart border. At the same time, left atrial appendage shadow is not prominent on the left border, possibly indicating previous closed mitral valvotomy with amputation of the left atrial appendage. Sternal wires used for fixing the sternum after sternotomy are also seen.
Annotated image at: http://cardiophile.org/2009/08/prosthetic-mitral-valve-starr-edward-prosthesis-sep/