Phonocardiography in the Assessment of Mitral Valve Disease

SUMMARY Phonocardiograms of 250 consecutive subjects of mitral valve disease have been examined. The findings in mild mitral stenosis and in predominant mitral incompetence are described. Seventy cases in which the state of the mitral valve was ascertained at operation have been analysed in more detail. The typical findings of “tight” mitral stenosis are described. Variations from this picture may occur where there is heavy mitral valve calcification, where severe pulmonary hypertension accompanies the development of a high pulmonary vascular resistance, and where there is significant aortic valve disease. The importance of the group of cases with severe pulmonary hypertension is emphasized. Cases in this group are often misdiagnosed, either because the signs are wrongly interpreted as being due to mitral incompetence or because the presence of mitral stenosis as the underlying cause of pulmonary hypertension is not recognized. The part played by phonocardiography in the diagnosis of these cases of mitral valve disease, and in the correct assessment of the state of the mitral valve in these and other cases, is stressed.