Pseudoejection sound in hypertrophic subaortic stenosis: an echocardiographic correlative study

Phonoechocardiographic studies were performed in 23 patients with hypertrophic subaortic stenosis. In ten patients a distinct systolic sound was recorded, usually along the lower left sternal border. In eight of these cases the sound was low or medium frequency. Unlike the ejection click of valvular aortic stenosis, the sound began 40-100 msec after the upstroke of the indirect carotid pulse and occurred close to the initial peak of the carotid pulse. This sound, termed pseudoejection sound, was associated with systolic anterior movement (SAM) of the anterior mitral leaflet on the echocardiogram. In all six patients studied with simultaneous phonoechocardiograms, the pseudoejection sound coincided with the sudden halting of SAM of the anterior mitral leaflet. Following provocative maneuvers the sound became louder, and its timing, as well as the sharp halting of SAM of the mitral leaflet, occurred earlier in systole. The pseudoejection sound probably results either from impact of the anterior mitral leaflet against the interventricular septum or more likely from deceleration of blood flow in the left ventricular outflow tract. The echo data support the association of the pseudoejection sound with significant left aventricular outflow obstruction,