Figure 199i

Base and aortic root phonocardiograms are recorded simultaneously with high- fidelity catheter- tipped micromanometers in the central aorta and left ventricle in a 23 year old man with mild valvular aortic stenosis(left panel)and in an elderly patient with severe calcification of the aortic valve(right panel) .In valvular aortic stenosis,the murmur is introduced by a loud aortic valvular ejection sound(AVE) . The peak gradient across the aortic valve was less than 30mm of mercury, and the systolic ejection murmur ends well before the prominent aortic closure sound. With calcific fixation of the aortic valve a valvular ejection sound is not recorded on either the base or the aortic root phono cardiogram,nor is an anacrotic notch present on the upstroke of the central aortic pressure trace. Note also that the aortic closure sound is barely recordable at thebase.