Comparisons between diastolic fluttering and reverse doming of anterior mitral leaflet in aortic regurgitation

In 27 patients with aortic regurgitation and nine patients with associated aortic stenosis, the incidence of reverse doming was studied by two-dimensional echocardiography and was compared with diastolic fluttering of the mitral valve. Reverse doming could be identified in four of six patients (66.7%) with mild aortic regurgitation and in 20 of 21 patients (95.2%) with moderate or severe aortic regurgitation (p less than 0.05). Fluttering of the anterior mitral leaflet was observed in all patients with mild aortic insufficiency and in 19 of 21 patients (90.5%) with moderate or severe aortic insufficiency. In patients with associated aortic stenosis, reverse doming was observed in three patients (33.3%), whereas fluttering was seen in six patients (66.7%). After aortic valve replacement, reverse doming persisted in one patient with a paravalvular leak. Reverse doming or fluttering was not seen in healthy volunteers or in 10 patients with congestive cardiomyopathy. Our data indicate that reverse doming is a helpful parameter for the diagnosis of aortic regurgitation.