Figure 199e

Simultaneous phonocardiograms are reported with the mitral valve
echocardiograms in three patients: mitral stenosis (left panel),left
myxoma(central panel), and prolapse of mitral valve( right- panel). In
each condition a loud M1 is present and coincident with the closing point of the mitral valve echocardiogram. Common to each condition is wide
separation of the mitral leaflets at the onset of left ventricular systole with high velocity closure occurring over a large excursion. In the left panel a mobile stenotic valve is demonstrated, and a loud opening snap is coincident with the E point. In the central panel, an early diastolic tumor plop(TP) is coincident with the maximum excursion of the tumor during its rapid descent into the ventricle. Note the presystolic crescendo murmur ( PSM) occurring during the rapid closure of the mitral valve in both mitral stenosis and Left atrial myxoma. In the right panel, a pansystolic murmur (P s M) with late systolic accentuation is secondary to the prolapse of the mitral valve with late systolic hammocking.