Late diastolic mitral regurgitation secondary to aortic regurgitation: Its relationship to the Austin Flint murmur

Lochaya, S; Igarashi, Masao; Shaffer, Aaron B.

doi:10.1016/0002-8703(67)90273-6

Cited by 44 publications

(9 citation statements)

References 19 publications

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“…'2-14 When direct recordings of left-sided intracardiac pressures became available, it was found that fluid-filled catheter systems showed a late diastolic or "reversed" pressure gradient from left ventricle to left atrium or pulmonary capillary wedge position. '5 '6 Lochaya et al 4 and other workers5s 7 cineangiographically demonstrated the occurrence of presystolic mitral regurgitation in patients with severe aortic insufficiency and "reversed" gradients. O'Brien and Cohen6 found early left atrial to left ventricular and late diastolic left ventricular to wedge or left atrial pressure gradients in all 12 of their patients with a Flint murmur which they defined as a mid-diastolic rumble.…”

Section: Methodsmentioning

confidence: 92%

Sound pressure correlates of the Austin Flint murmur. An intracardiac sound study.

Reddy¹,

Curtiss²,

Salerni³

et al. 1976

Circulation

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SUMMARY Mitral valve motion and pressure correlates of the Austin Flint murmur (AFM) were investigated in nine patients with aortic regurgitation using high fidelity catheter tip micromanometers and the mitral valve echocardiogram (MVE). External phonocardiography demonstrated a mid-diastolic murmur (MDM) in eight subjects and a presystolic murmur (PSM) in five. Maximum intensity of both AFM components was found in the left ventricular (LV) inflow tract; the murmur was not recordable in the left atrium (LA). In two patients, an apparent AFM was recorded in the intracardiac phonocardiogram when absent externally. Only one subject had a significant late diastolic "reversed" or LV to LA gradient; in this patient, presystolic mitral regurgitation was shown angiographically but no PSM was present and MVE revealed IN 1862, AUSTIN FLINT described an apical presystolic murmur in two patients with "considerable" aortic regurgitation who had no evidence of organic mitral stenosis at autopsy.' This great clinician believed the murmur of mitral valve obstruction to be limited to presystole. He attributed the functional murmur to ". . . distension of the [left] ventricle [so] that the mitral curtains are brought into coaptation and when the auricular contraction takes place, the mitral direct current passing between the curtains throws them into vibration and gives rise to the characteristic blubbering murmur." Since its original description, the Flint murmur has been broadened to include a mid-diastolic component.2Modern investigators have assigned the genesis of the presystolic component to two mutually exclusive causes diastolic mitral regurgitation4-' and increased velocity of antegrade flow across a closing mitral valve.8 9 The investigative techniques utilized by proponents of the former explanation have primarily been pressure measurement and cineangiography, and of the latter cause, echocardiography. Simultaneous high fidelity micromanometer pressure determinations and intracardiac phonocardiography have not previously been reported in patients with an Austin Flint murmur. Since these two techniques would be of significant value in attempting to resolve the discrepancies posed by the above explanations, the present study was undertaken to obtain information that could further elucidate the genesis of the Austin Flint murmur. absence of atriogenic mitral valve re-opening. In two subjects, a PSM disappeared from the external phono when a "reversed" gradient occurred during the diastolic pause following a ventricular premature systole; this LV to LA gradient was associated with diastolic mitral regurgitation recordable in the left atrial phono. In two patients, LV inflow phono showed the MDM to begin 80-120 msec after the aortic second sound and during the D to E phase of the MVE. The rate of early diastolic mitral valve closure in patients (152 ± 24 mm/sec) was not significantly different from 13 normals (232 i 30 mm/sec). With regard to the genesis of the AFM, the present study concludes: 1) diastolic mitral regurgita...

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Section: Methodsmentioning

confidence: 92%

Sound pressure correlates of the Austin Flint murmur. An intracardiac sound study.

Reddy¹,

Curtiss²,

Salerni³

et al. 1976

Circulation

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“…Severe aortic insuffi ciency or artifactural lowering of the left atrial pressure might partially explain the finding. Severe aortic insufficiency would be unlikely to fully account for this reversed mitral gradient, because in our patient the re versed gradient was pan-diastolic and not end-diastolic [11,13,18] and there was no diastolic mitral regurgitation [1], Spurious lowering of the left atrial pressure may occur [12] if the Brockenbrough catheter had per forated the left atrium and recorded pressure in both the left atrium as well as in the pericardial sac. However, in our patient there is no evidence that the left atrium was perforated at the time of cardiac catheterization.…”

Section: Discussionmentioning

confidence: 99%

Massive Left Atrial Thrombus: A Case Report

Saksena¹,

Kroll²,

Boer³

1976

Cardiology

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This case report describes a patient with aortic and mitral valvular disease who had a massive left atrial thrombus. The left atrial thrombus produced a disappearance of signs of mitral stenosis and a reversed pan diastolic mitral valve gradient. This gradient occurred in the absence of any diastolic mitral insufficiency and may have been due to artifactual lowering of the left atrial pressure by an organized left atrial clot.

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“…Changes in the a wave correlated well with corresponding changes in left heart pressures but not with variations in volume. Of 15 patients in whom the ratio of the a wave to the total excursion during systole (a/H ratio) was .13%, 11 had left ventricular end-diastolic pressures (LVEDP) >20 mm Hg. All patients with a/H ratios >15% had abnormal LVEDP.…”

Section: Discussionmentioning

confidence: 99%

The Austin Flint Murmur and the a Wave of the Apexcardiogram in Aortic Regurgitation

1971

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SUMMARYHemodynamic data from 45 patients with either aortic regurgitation (with and without the Austin Flint murmur) or aortic regurgitation and mitral stenosis were correlated with the a-wave percentage amplitude of the apexcardiogram. Changes in the a wave correlated well with corresponding changes in left heart pressures but not with variations in volume. Of 15 patients in whom the ratio of the a wave to the total excursion during systole (a/H ratio) was .13%, 11 had left ventricular end-diastolic pressures (LVEDP) >20 mm Hg. All patients with a/H ratios >15% had abnormal LVEDP. The converse was not true; 13 patients had elevated LVEDP with normal a/H ratios. Patients with aortic regurgitation and mitral stenosis had a/H ratios similar to those of normal subjects.The Flint murmur showed a significant correlation with left ventricular volume changes. Its

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Late diastolic mitral regurgitation secondary to aortic regurgitation: Its relationship to the Austin Flint murmur

Cited by 44 publications

References 19 publications

Sound pressure correlates of the Austin Flint murmur. An intracardiac sound study.

Sound pressure correlates of the Austin Flint murmur. An intracardiac sound study.

Massive Left Atrial Thrombus: A Case Report

The Austin Flint Murmur and the a Wave of the Apexcardiogram in Aortic Regurgitation

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