HAeMODYNAMIC EFFECTS OF SEVERE AORTIC REGURGITATION

In free aortic regurgitation, the aortic diastolic pressure falls and the left ventricular end-diastolic pressure may rise above normal. In severe cases, these two pressures may equalize. We have recently demonstrated this phenomenon in a patient who, in addition, showed the unusual feature of premature mitral valve closure preceding atrial contraction. A search of the published material showed only 6 other instances in which such early mitral closure was caused by aortic reflux. Review of our catheterization data on nearly 200 patients with aortic disease disclosed no other instance, although there were 7 others in whom aortic and ventricular diastolic pressures equalized: in 2, this occurred constantly at the end of diastole, and in the other 5, equilibration occurred occasionally during long diastolic pauses following premature ventricular contractions. We will first present a detailed report of the single patient (Case 1) in whom equalization of aortic and left ventricular diastolic pressures was associated with premature mitral valve closure, and then review all 8 patients from our series in whom equalization of aortic and left ventricular diastolic pressures was found.