This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by MEADOWS, W. R. Articles by SHARP, J. T. Search for Related Content PubMed Articles by MEADOWS, W. R. Articles by SHARP, J. T.

(Circulation. 1963;28:251.)
© 1963 American Heart Association, Inc.

---

Premature Mitral Valve Closure

A Hemodynamic Explanation for Absence of the First Sound in Aortic Insufficiency

W. R. MEADOWS M.D.¹; STELLA VAN PRAAGH M.D.¹; MEILUTE INDREIKA M.D.¹; J. T. SHARP M.D.¹

¹ From the Cardiopulmonary Laboratories of the Veterans Administration Hospital, Hines, Illinois, and the Children's Hospital, Buffalo, New York; the Departments of Medicine of the Stritch School of Medicine, Loyola University, and the University of Illinois College of Medicine; and the Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, New York.

The phenomenon of premature mitral valve closure is described in three patients with severe aortic insufficiency and related to absence of the first heart sound.

The occurrence of premature mitral closure is favored by severe aortic regurgitation probably with increased impedance to left ventricular filling.

Available evidence suggests that this phenomenon usually occurs in the more rapidly developing forms of aortic incompetence (bacterial endocarditis, post surgical, and traumatic rupture of the valve), that it is uncommon, and that it often implies a grave prognosis.

It should be suspected when the apical first heart sound is absent in aortic incompetence.