The Pulsed Doppler Coronary Artery Catheter

would be of use to know by pulsed Doppler echocardiography whether or not the origin of the murmur in question is consistent with a rheumatic process. When there has been no firm basis for the diagnosis of rheumatic fever, and pulsed Doppler echocardiography shows only a VSD, removal of the diagnosis of rheumatic fever and discontinuation of rheumatic fever prophylaxis may be considered. In cases where the severity of VSD or MR may approach the surgical range, invasive studies are more appropriate, and there is usually less difficulty in distinguishing between VSD and MR. Questions may remain, however, especially if the VSD is of endocardial cushion type, with associated mitral abnormalities, or in situations where left ventricular angiography performed via the transatrial route is associated with so-called catheter induced mitral insuffici-