The apical systolic murmur in mitral stenosis.

The purpose of this work was to determine how reliable a guide an apical systolic murmur can be to the finding at mitral valvotomy of incidental mitral regurgitation complicating dominant mitral stenosis. The history of the systolic murmur in mitral stenosis is a confused one, since general agreement was not reached about the timing of systolic and diastolic murmurs in mitral stenosis for nearly a century after Laennec (1819) first described the " bruit de souffiet " and " bruit de scie." Thus Ormerod (1864), Dickinson (1887), and Brockbank (1910) held that the characteristic murmur in mitral stenosis was in early systole and due to associated mitral regurgitation. On the other hand, Fauvel (1843), Gairdner (1861), and Fagge (1870) believed that the murmur was in late diastole and resulted from obstruction to the passage of blood through the mitral valve, as Laennec had originally suggested. With the advent of the electrocardiogram and phonocardiogram, the time of the murmur was fixed more accurately in the cardiac cycle. It became accepted that both diastolic and systolic murmurs were heard in mitral stenosis, the diastolic murmur being of chief importance as indicating stenosis, the systolic murmur, when present, being of secondary significance only, since it indicated merely a degree of incidental mitral regurgitation. With the introduction of mitral valvotomy and the consequent need for more detailed knowledge of the functional pathology of the mitral valve, interest has been re-awakened in the systolic murmur as one possible guide to the presence of regurgitation complicating mitral stenosis (Baker et al., 1952; Froment and Gravier, 1952; Abelmann et al., 1953; Sellors et al., 1953).