Systolic Click Syndrome
نویسنده
چکیده
Systolic Click Syndrome To the Editor: I have read with interest the article by Liedtke et al. (Circulation 47: 27, 1973) who have demonstrated a reduction in the extent of shortening of the proximal ventricular segment and the mitral valve ring, with an increase in the diameter of the ring in some of their patients. It is probable, however, that this angiographic appearance may have been due to the superimposition of the "doughnut-like" prolapsed leaflets' over the mitral ring and the proximal ventricular segment. In our experience, the right anterior oblique view is the projection of choice for demonstration of mitral valve prolapse;' the lateral view used by the authors rnay have made it difficult for them to demonstrate the prolapse and may have resulted in the superimposition which I postulate. Assuming that a rigidity of the proximal segment of the left ventricle was proved, this should not be construed as pointing to a primary myocardial etiology of this syndrome. Indeed, similar rigidity of the posterobasal segment of the left ventricle due to secondary fibrosis has been found in rheumatic mitral stenosis, a primary valvular disorder.2 The angiographic picture described by Liedtke et al. may be due to the fibrotic friction lesions of the left ventricular endocardium associated with "hooding of the mitral valve";3 adhesions of the chordae to the endocardium as well as collagenous prolongation into the subjacent myocardium have also been described. Friction by the elongated chordae, which are abnormally close to the endocardium, was considered as the mechanism of these lesions. In summary, the data presented by the authors, even if confirmed, do not necessarily indicate primary myocardial involvement in this syndrome which is probably secondary to myxomatous degeneration of the mitral leaflets and their chordae.4 ROBERT M. JERESATY, M.D. Section of Cardiology St. Francis Hospital Hartford, Connecticut
منابع مشابه
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