The “A-dip” of diastolic mitral regurgitation: An unusual Doppler flow pattern in a patient with severe aortic insufficiency and complete heart block

This is an unusual case of diastolic mitral regurgitation (MR) with a high diastolic velocity jet and prolonged jet duration related to a combination of acute severe aortic insufficiency and high-degree atrioventricular block. This case illustrates an interesting hemodynamic phenomenon with multiple transient decreases in the pressure gradient between the left ventricle and left atrium during diastole related to a temporary increase in left atrial pressure associated with atrial contraction.