Premature pulmonary valve opening.

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Abstract
Premature opening of the pulmonary valve (opening independent of atrial or ventricular systole) was originally described in a case of sinus of Valsalva rupture into the right atrium. Additional cases [5] in which the pulmonary valve opened prematurely were observed. Entities encountered included constrictive pericarditis; Loeffler''s endocarditis; Ebstein''s anomaly with tricuspid regurgitation; tricuspid regurgitation following tricuspid valvulectomy and pulmonary regurgitation accompanied by atrial septal defect. In the first 2 cases, premature pulmonary valve opening was probably due to restriction of diastolic filling of the right ventricle with subsequent early diastolic rise in pressure equaling or exceeding pulmonary artery diastolic pressure. In the latter 3 patients, the increased volume of blood entering the right ventricle again appeared to result in a rapid rise in initial right ventricular diastolic pressure and to produce premature opening of the pulmonary valve. Premature pulmonary valve opening did not appear specific for any particular clinical entity but reflected the relative pressures in the right ventricle and pulmonary artery during diastole.

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