Mid-systolic sound associated with aortic insufficiency and bisferiens pulse

Systolic ejection clicks, often associated with cardiac disease, can be distinguished from mid-systolic clicks of mitral and tricuspid origin, which are frequently benign. A different mid-systolic sound has been recognized, with timing similar to the mid-systolic clicks, which is associated with aortic insufficiency. This report describes a case in which such a sound was identified prior to aortic valve replacement, and disappeared with surgery, thus adding evidence to previous concepts of the origin of this sound, and its relationship to the hemodynamic abnormality associated with aortic valvular regurgitation.