Systolic Fluttering of the Noncoronary Cusp of the Aortic Valve and the Posterior Wall of the Aortic Root – A Sign of Mitral Regurgitation due to Dysfunction of the Posterior Leaflet of the Mitral Valve

Ten consecutive patients with severe isolated mitral regurgitation were studied. All the patients were evaluated by physical examination, EKG, chest X‐ray, M‐mode echocardiogram, and left ventricular angiogram. In eight patients a systolic murmur of mitral regurgitation radiated to the left parasternal and aortic areas. All of these patients demonstrated fluttering of the noncoronary cusp of the aortic valve and the posterior wall of the aortic root. Two patients in whom the systolic murmur of mitral regurgitation did not radiate to left parasternal and aortic areas, did not show fluttering of the noncoronary cusp and the posterior aortic wall. These patients had a classical murmur of mitral regurgitation that radiated to the left axilla. A review of 120 normal echocardiograms revealed fluttering of the right coronary cusp in three cases. None of these echocardiograms demonstrated fluttering of the noncoronary cusp or the posterior wall of aorta. The findings lead us to conclude that the presence of systolic fluttering of the noncoronary cusp and the posterior wall of the aorta is suggestive of mitral regurgitation due to dysfunction of the posterior leaflet of the mitral valve. Isolated fluttering of the right coronary cusp is a nonspecific finding.