Mechanographic evaluation of left atrial activity in mitral valve prolapse

Twenty-five patients suffering from mitral valve prolapse were studied to demonstrate any diagnostic modifications of the indirect (esophageal) left atrial pulse (ESO). Valvular prolapse is demostrated on the ESO by a sudden change in slope of the curve after the "x" point, in coincidence with a midsystolic click. Late systolic mitral insufficiency, when associated with prolapse is illustrated on the ESO tracing in two ways: a) an abnormally tall "v" wave; b) a late systolic plateau which begins immediately after the click and continues beyond the second heart sound. After the infusion of methoxamine or isometric exercise the ESO is usually of the a) conformation, while after the inhalation of amyl nitrite the tracing tends to be of the b) type. The "c" wave is at times altered but not always. This alteration is characterized by a greater amplitude and sharper peak. Based on the physiopathogenesis of the alterations of the ESO, it can be stated that they are specific, and sensitive enough to be both qualitative and quantitative.