Reversed mitral diastolic gradient in aortic incompetence.

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Abstract
Hemodynamic and clinical data are presented on 6 patients who had a reversed mitral diastolic gradient. These patients all had significant aortic incompetence either alone or combined with other lesions such as mild aortic stenosis, mitral or tricuspid valve disease. In contrast to previously reported cases, this phenomenon can occur without equilibration of aortic and left ventricular pressure during diastole. Several patients had either atrial fibrillation or 1st degree heart block. These features appear to facilitate recognition of a reversed mitral diastolic gradient. Although this phenomenon should theoretically lead to a soft 1st heart sound, this was not always abserved; the reasons for this are discussed.