Presystolic Mitral Regurgitation in Severe Aortic Incompetence Observed by Cineangiography

Abstract

Four patients with severe isolated aortic regurgitation following bacterial endocarditis showed an early diastolic ‘functional mitral stenosis’ with a maximal pressure difference across the valve of 5–20 mm Hg. At the end of diastole, the left ventricular pressure exceeded the left atrial pressure, and the peak pressure difference varied between 13 and 33 mm Hg. In two of these patients a presystolic mitral regurgitation was observed on cineangiography when contrast medium was injected into the ascending aorta. In a case with complete atrioventricular block, presystolic mitral regurgitation was observed only at a low ventricular rate but not when the ventricular rate was increased by pacing. Two types of low frequency apical diastolic murmurs were observed: one in early diastole during the phase of ‘functional mitral stenosis’ (in one case only) and a presystolic murmur during the phase of reversed pressure differences (in all cases). The later type of murmur may be explained by presystolic mitral regurgitation, which was demonstrated on cineangiography in two of the four patients. This presystolic ‘functional’ mitral regurgitation must be distinguished on the angiogram from a true systolic regurgitation caused by diseased valve leaflets.