PHASES OF DIASTOLE IN VARIOUS SYNDROMES OF MITRAL VALVULAR DISEASE

Abstract

Left heart pressure pulses, phonocardiograms, and displacement curves of the left ventricular apex were recorded in patients with mitral valvular disease, and correlated with the findings at operation. Various patterns of left ventricular filling and stasis were recognized, and each was considered to be diagnostic of a particular valvular lesion. A prolonged phase of filling that began with the 3rd heart sound was present in every case of severe mitral incompetence. The belief that the 3rd heart sound is caused by the left ventricle suddenly reaching the limit of its distension is not consistent with this finding. At the time at which the left atrial annular ascent point was recorded, it was noted that the 3rd heart sound occurred; the apex of the left ventricle moved inwards if a 3rd heart sound was present; the "y" descent of the left atrial pressure and the outward movement of the left ventricular apex were suddenly slowed; and the diastolic murmur of mitral incompetence made its appearance or increased suddenly in loudness. A theory that accommodates these findings is presented.