Diastolic mitral regurgitation. Haemodynamic and angiographic correlation.

A better understanding of the factors involved in ensuring competence of the mitral valve based on knowledge of the function of the leaflets, chordae tendineae, and papillary muscles has expanded the clinical range of systolic mitral regurgitation. For all this, diastolic mitral regurgitation remains a curiosity. Late diastolic mitral regurgitation has been described together with reversal of the left atrioventricular pressure gradient in experimental and clinical studies (Williams et al., 1968; Rutishauser et al., 1966; Lochaya, Igarashi, and Shaffer, 1967). In these reports the mitral valve was established or judged to be normal, and, therefore, incomplete closure of the valve was a causal factor of mitral regurgitation. A diseased mitral valve unable to close tightly during systole might be regurgitant during diastole as well if left ventricular pressure were to exceed left atrial pressure. In the past year we have recognized systolic and diastolic reflux across abnormal mitral valves in 4 patients who represent a spectrum of valvular heart disease. We wish to present the haemodynamic and angiographic evidence for diastolic mitral regurgitation. Its incidence in 4 of 50 consecutive patients studied for rheumatic heart disease is frequent enough to make it something to consider in any patient with mitral valve disease.