THE DIAGNOSIS OF MITRAL INCOMPETENCE FROM LEFT ATRIAL PRESSURE CURVES

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Abstract
Left atrial and ventricular pressure tracings were taken at operation on 77 patients with mitral valve disease. Neither the height of the v wave measured from the atrial pressure immediately preceding the a or c wave nor the maximum height of the v wave above the maximum height of the c wave (v-c difference) correlated well with the degree of mitral incompetence as estimated by palpation of the mitral orifice. Likewise, the Ry/v ratio (Owen and Wood, 1955) did not correlate. However, the "corrected x descent", calculated by subtracting (1) the atrial pressure just prior to the a or c wave and (2) the height of the c wave from the pressure at the nadir of x descent (or if there is no x descent, the atrial pressure is measured at the end of the first 3d of ventricular diastole), was felt to be of value. When the "corrected x descent" is > 5 mm Hg, there is mitral incompetence; when it is under 5 mm Hg, there is no severe incompetence although moderate incompetence may exist.