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Cardiac catheterization and phonocardiography data were obtained from patients with mitral stenosis at rest and during exercise. There was a linear relationship between the percentage decrease of the interval from closure of the aortic valve to the mitral valve opening snap (A2-OS) and the percentage increase[see figure in the PDF file]of the left atrial mean pressure from rest to exercise. The duration of the A2-OS interval was an effective indicator of the level of the left atrial mean pressure during exercise. The duration of the A2-OS interval during exercise allowed separation of patients with mild stenosis from those with moderate or severe stenosis but could not be used to distinguish moderate stenosis from severe stenosis.

The Second Sound-Mitral Opening Snap (A2-OS) Interval during Exercise in the Evaluation of Mitral Stenosis