Mitral Regurgitation in the Setting of Acute Aortic Regurgitation: It's All About Timing

Presystolic mitral regurgitation is a rare, echocardiographic finding that is often ignored and misdiagnosed given its occurrence in the diastolic phase of the cardiac cycle. However, its presence indicates underlying structural or functional abnormalities that warrant further investigation, such as severe aortic regurgitation, atrioventricular dyssynchrony, and cardiomyopathies with elevated left ventricular end-diastolic pressure. The management of presystolic mitral regurgitation focuses on repairing the underlying pathology. In this E-challenge, the authors review a case of presystolic mitral regurgitation in the setting of acute aortic regurgitation and emphasize the clinical significance of recognizing and distinguishing it from functional mitral regurgitation.