Mitral valve closure in atrial flutter.

Abstract

12 patients who had atrial flutter without clinical, echocardiographic or angiographic evidence of aortic insufficiency were studied with simultaneous echo- and phonocardiograms. In patients with high-grade atrioventricular (AV) block, the mitral valve opened and closed with each flutter wave. Of seven patients, two had persistent and five had intermittent early mitral valve closure before QRS inscription. In five patients (three with 2:1 AV block) the mitral valve closed on time. In one patient with a mitral valve prosthesis, echocardiography and cinefluorography demonstrated closure during mid-diastole, with reopening in late diastole after a flutter wave. Final valve closure occurred before the onset of the QRS, and each closure was associated with a click. Simultaneous phonocardiographic analysis in these patients demonstrated that the first heart sound intensity was inversely related to the degree of mitral valve preclosure. This relationship was independent of the length of the RR interval. Thus, atrial flutter independent of any other cause of abnormal hemodynamics may produce early mitral valve closure. The echocardiographic finding of premature mitral arrhythmias, may not have the same diagnostic or prognostic significance previously described in patients with sinus rhythm and normal AV conduction.

Premature closure of prosthetic mitral valves as a consequence of gravity

“…Therefore, the observed premature closure of prosthetic mitral valves in patients who have concomitant severe aortic regurgitation is readily explained by the rise of left ventricular diastolic pressure above left atrial pressure [4]. Similarly, premature prosthetic mitral closure that is occasionally seen in patients with first degree atrioventricular block [9,12] or atrial flutter [13] can possibly result from a fall of left atrial pressure below left ventricular end-diastolic pressure with atrial relaxation. Presystolic closure of prosthetic mitral valves in patients with atrial fibrillation and little or no aortic regurgitation, however, can hardly be attributed to the same mechanism.…”

“…Related echocardiographic, phonocardiographic, and cinefluorographic findings also have been described [1][2][3][4][5][6][7][8][9][10][11][12]. In several cases, a causal relationship has been established, or suggested, between premature closure and concomitant abnormalities such as aortic regurgitation [4,10], atrial flutter [13], or the presence of first degree atrioventricular block [6,8,9,12]. Most frequently, however, premature closure is seen in patients with atrial fibrillation during prolonged diastolic periods in the absence of aortic regurgitation [ 1 1, 12,14].…”

Premature closure of prosthetic mitral valves during late diastole: A consequence of gravity

“…Therefore, the observed premature closure of prosthetic mitral valves in patients who have concomitant severe aortic regurgitation is readily explained by the rise of left ventricular diastolic pressure above left atrial pressure [4]. Similarly, premature prosthetic mitral closure that is occasionally seen in patients with first degree atrioventricular block [9,12] or atrial flutter [13] can possibly result from a fall of left atrial pressure below left ventricular end-diastolic pressure with atrial relaxation. Presystolic closure of prosthetic mitral valves in patients with atrial fibrillation and little or no aortic regurgitation, however, can hardly be attributed to the same mechanism.…”

“…Related echocardiographic, phonocardiographic, and cinefluorographic findings also have been described [1][2][3][4][5][6][7][8][9][10][11][12]. In several cases, a causal relationship has been established, or suggested, between premature closure and concomitant abnormalities such as aortic regurgitation [4,10], atrial flutter [13], or the presence of first degree atrioventricular block [6,8,9,12]. Most frequently, however, premature closure is seen in patients with atrial fibrillation during prolonged diastolic periods in the absence of aortic regurgitation [ 1 1, 12,14].…”

Clapping atrio-ventricular valves

“…TTE also documented another interesting finding (online video 1), that is, premature closure of mitral and tricuspid valves. Greenberg et al originally described the finding of premature mitral valve closure by M-mode echocardiogram 2. This underscores the utility of echocardiogram to identify atrial rhythm, and also the importance of atrial mechanics in the closure of the mitral valve.…”