Early Diastolic Sound Associated With Mitral Valve Prolapse

The prolapsing or billowing mitral valve syndrome has received much attention in recent years because of both its ubiquity and the occasional occurrence of serious problems in relation to it.1-4 Several physical findings have been related to this condition. The most striking and frequent finding is a midsystolic click (or clicks), which is followed frequently by a late systolic murmur.5,6Some patients have had a holosystolic murmur, sometimes rather intense, without any click at all.5-7Other patients demonstrate completely normal results of cardiac examinations in the presence of typical echocardiographic and angiographic evidence of prolapse.8,9 We have recently observed a patient with this syndrome who demonstrated, in addition to the midsystolic click and late systolic murmur, a striking early diastolic sound. Echocardiographic and phonocardiographic studies were carried out, along with pharmacologic interventions, in an effort to determine the nature of this sound. PATIENT SUMMARY A 37-year-old