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

Abstract

Severe aortic insufficiency may accelerate mitral valve closure. This echocardiographic finding was noted in several patients with the acute onset of severe aortic insufficiency. Accordingly, the total echocardiographic series was examined retrospectively for early closure of the mitral valve (ECMV) in the setting of aortic insufficiency, and it was found in 11 of 53 patients with confirmed aortic insufficiency. During the study, ECMV was fortuitously found in 2 other patients without aortic insufficiency. ECMV occurred in late diastole following the echocardiographic 'A' wave, often associated with a suppressed 'A' wave (classified as type 'A' ECMV), or in mid diastole in the absence of an 'A' wave (type 'B' ECMV). ECMV presence and subtype, along with other clinical parameters, appeared to be useful in the series 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 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 conduction abnormalities, coexistent 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.