“…Any suspicion of mechanical valve failure requires echocardiography, ideally transoesophageal 4. St. Jude Medical valves are made of pyrolytic carbon and are not radio-opaque on a standard chest x-ray unless the cusps are seen end-on 5. Fluoroscopy is a simple screen to check the mobility of the valve cusps if transoesophageal echocardiography is not available immediately.…”