Sound-pressure correlates of the aortic ejection sound. An intracardiac sound study.

The sound-pressure correlates of the aortic ejection sound (AES) were studied in six patients without aortic valve disease (group 1) and in nine patients with valvular aortic stenosis (group 2) during diagnostic left heart catheterization. Aortic root sound and pressure events were recorded by a catheter-tip micromanometer simultaneously with the external phonocardiogram, indirect carotid pulse, and electrocardiogram. The AES in group 1 patients was coincident with the onset of pressure rise in the aortic root. This relationship was not altered by drug administration, although variations in the amplitude of the AES occurred. It was concluded that the AES in patients without aortic valvular disease is an exaggerated ejection component of the normal first heart sound, and that it is a root phenomenon related to the forceful ejection of blood into the aorta. The AES in group 2 patients was delayed 24 to 40 msec after the onset of pressure rise in the aortic root, was coincident with the anacrotic notch, and introduced the aortic ejection murmur. Aortic root sound and pressure were recorded simultaneously with aortic valve motion during angiography in two patients utilizing a cine trace system. The AES occurred when the domed valve reached its maximal excursion, and the interval between the onset of aortic pressure rise and the AES was equal to the total time required for the piston-like ascent of the dome. It was concluded that the AES in valvular aortic stenosis is valvular in origin. The amplitude of the valvular AES correlated best with valve mobility on the angiogram, and no correlation existed between its presence and the severity of the valvular stenosis.