Echocardiographic demonstration of early mitral valve closure in severe aortic insufficiency. Its clinical implications.

Abstract

Severe aortic insufficiency may accelerate mitral valve closure. We noted this echocardiographic finding in several patients with the acute onset of severe aortic insufficiency. Accordingly, we examined our total echocardiographic series retrospectively for early closure of the mitral valve (ECMV) in the setting of aortic insufficiency and found it in 11 of 53 patients with confirmed aortic insufficiency. During our study ECMV was fortuitously found in two other patients without aortic insufficiency, ECMV occurred in late diastole following the echocardiographic "A" wave, often associated with s suppressed "A" wave (type "B" ECMV). ECMV presence and subtype, along with other clinical parameters, appeared to be useful in the serial evaluation of the patient with severe aortic insufficiency. Additionally, the analysis of ECMV type helped to clarify the mechanism and significance of the Austin Flint murmur. Analysis of 17 patients with and without ECMV, with severe aortic insufficiency judged clinically (NYHA functional class III or IV) and angiographically (3+), indicated that only ECMV patients had acute aortic insufficiency and demonstrated diminished left ventricular size following successful aortic valve replacement. Although due primarily to aortic insufficiency, ECMV could be influenced by rhythm or conducted abnormalities, co-existent cardiac lesions, and pharmacologic interventions. Exclusive of these factors, ECMV was an excellent sign of acute, torrential aortic insufficiency, and a simple noninvasive indicator of the patient requiring immediate aortic valve replacement.