Figure 199b

Base and apex phonocardiograms are recorded simultaneously with the mitral valve echocardiogram in a 62 year old man who developed acute mitral regurgitation secondary to rupture of the chordae tendinae of a myxomatous valve. During diastole multiple echoes arise from the flail posterior mitral leaflet(PML), and during early ventricular systole effective mitral valve closure idoes not occur resulting in an inaudible low frequency vibration on the apex phonocardiography. During systole, there is separation of the anterior(AML) and posterior leaflets, resulting in severe mitral regurgitation. The murmur has a crescendo decresescendoe contour simulating the murmur of the aortic stenosis prior to A2. Wide physiologic splitting of S2. the prominent S4 present on the apex phonocardiogram was associated with an apical presystolic murmur.

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