Assessing the Hemodynamic Severity of Acute Aortic Regurgitation Due to Infective Endocarditis

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Abstract
Nine patients who underwent aortic-valve replacement for acute aortic regurgitation due to infective endocarditis were studied for clinical features that may be useful in assessing the severity of this condition. The traditional physical signs of a wide pulse pressure were absent. As compared to a group of patients with chronic aortic regurgitation, the mean ( ± S.D.) pulse pressure (55 ± 7 vs. 105 ± 22 mm Hg), left ventricular end diastolic volume (146 ± 28 vs. 264 ± 64 ml per square meter), and stroke volume(89 ± 22 vs. 163 ± 57 ml per square meter) were significantly smaller in the acute group (P < 0.01). Left ventricular pressure exceeded left atrial pressure in late diastole, causing premature closure of the mitral valve, and the degree of early closure reflected the increase in left ventricular end diastolic pressure. Premature closure of the mitral valve was predictable by the Austin-Flint murmur and was demonstrated by echocardiography in all patients. Those with echocardiographic signs of very early mitral-valve closure have severely volume-overloaded ventricles and are candidates for early valve replacement. (N Engl J Med 293:108–113,1975)