Mitral Insufficiency Simulating Aortic Stenosis

Two patients with mitral insufficiency presumably secondary to rheumatic heart disease are reported in whom loud systolic murmurs and thrills in the aortic area simulated aortic stenosis. Left heart catheterization in both patients disclosed significant mitral insufficiency but no evidence for aortic stenosis or intracardiac shunt such as ventricular septal defect. Phonocardiography demonstrated the holosystolic characteristics of the aortic area murmurs and was indispensable in documenting their mitral origin. A regurgitant jet striking the left atrial wall in close proximity to the aortic valve, previously reported in rupture of the chordae tendineae, appears the probable mechanism of the aortic murmur and thrill.