Atriogenic mitral valve reflux: diastolic mitral incompetence following isolated atrial systoles.

Cardiac and aortic pressures were recorded after stellate gangliooectomy and vagotomy. Acute heart block was produced by injecting the atrioventricular node, and atrial and ventricular systoles were controlled electronically to occur independently or in any desired relationship. Angiocardiograms recorded on video tape after injections of 4 ml 69% Renovist into the left ventricle were analyzed with a videodensitometer able to detect small refluxes of contrast medium into the left atrium and correlate them with phases of the cardiac cycle. When ventricular driving was temporarily suspended but atrial driving continued, pressure records indicated mitral valve closure after each atrial systole, but reflux of contrast medium into the atrium occurred after each systole not followed by a normally sequenced ventricular systole. Driving with a 2 : 1 atrioventricular stimulation resulted in reflux, with the alternate atrial contraction dissociated from ventricular systole. Thus, the mitral valve was not effectively closed by atrial systoles that were not followed by normally sequenced ventricular systoles. ADDITIONAL