TIME RELATIONSHIPS OF THE LEFT ATRIAL V WAVE IN MITRAL VALVULAR DISEASE

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Abstract
Heart sounds and left atrial pressure pulses were recorded simultaneously in 18 patients disabled from mitral stenosis, mitral stenosis with regurgitation, or mitral regurgitation. Diagnostic criteria and methods of investigation and measurement are described in detail sufficient for the work to be repeated. With one exception, using the method described, left atrial "v" peaks occurred 0.01 to 0.04 sec. after aortic valve closure; and 0.01 to 0.1 sec. before mitral opening snap vibrations. These time relationships were not apparently affected by the presence of moderate or severe mitral regurgitation. It is suggested that active dilatation of the atrio-ventricular ring causes left atrial pressure to fall from the apex of the "v" wave to the point at which the mitral valve opens. Diagnostic formulae that relate the first 0.1 sec. of "y" descent to atrio-ventricular blood flow are based upon the apparently incorrect assumption that left atrial "v" wave peaks coincide with mitral valve opening. The presence of mitral regurgitation does not appear to shorten the interval between the second heart sound and the mitral opening snap.