Figure 199a

Base and apex phonocardiograms are recorded simultaneously with the mitral valve echocardiogram in a 62 year old man who developed acute mitral regurgitation secondary to rupture of the chordae tendinae of a myxomatous valve. During diastole multiple echos arise from the flail posterior leaflets(PML), and during early ventricular systole effective mitral valve closure does not occur, resulting in an inaudible low- frequency vibration on the apex phonocardiogram. During systole, there is separation of the anterior (AML) mail and posterior mitral leaflets, resulting in severe mitral regurgitation. The murmurr has a crescendo-decrescendo contour simulating the murmur OF aortic stenosis ending prior to A2. Wide physiological splitting of S2 is present . The prominent S4 on the apex phonocardiogram was associated with an apical systolic presystolic impulse.