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(Circulation. 1998;98:2782-2783.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Austin Flint Murmur

John Oshinski, PhD; Robert Franch, MD; Murray Baron, MD; Roderic Pettigrew, PhD, MD

From the Departments of Radiology and Medicine (Cardiology) (R.F.), Emory University School of Medicine, Atlanta, Ga.

Correspondence to John Oshinski, PhD, Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322.

A55-year-old man complained of dyspnea on exertion. On examination, he had a loud parasternal diastolic murmur indicative of aortic valve regurgitation and an apical middiastolic and presystolic rumble (Austin Flint murmur). The patient was referred for a cardiac MRI examination to quantify aortic regurgitation and determine ventricular volumes.

A horizontal long-axis imaging plane through the aortic valve and the apex of the heart was used. Sixteen ECG-gated gradient-echo (bright-blood) images were obtained at equally spaced time points over the cardiac cycle. An early-systolic image shows the mitral valve leaflets closed and aortic valve open in a normal fashion (Figure 1). An early-diastolic image shows a dark regurgitant jet of aortic insufficiency extending posteriorly, impinging on the anterior leaflet of the mitral valve before the mitral valve opens during isovolumic relaxation (Figure 2). A middiastolic image shows the regurgitant jet continuing to impinge on the anterior leaflet of the mitral valve (Figure 3). The jet limits the opening swing of the anterior leaflet and restricts the mitral orifice to opening only 6 mm, producing a functional mitral stenosis. A late-diastolic image taken at the R wave shows the pandiastolic nature of the regurgitation; the regurgitant jet is present even as the mitral valve is closed (Figure 4). This type of severe aortic regurgitant jet has been linked to the Austin Flint murmur, although the exact cause of the murmur is still not known. Several theories have been suggested for the origin of the murmur: (1) vibration of . . . [Full Text of this Article]