Circulation
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Although mitral valve prolapse is often associated with a systolic click or murmur, it is not widely appreciated that a sound or murmur may also occur in diastole. Nine patients with a systolic click or murmur and echocardiographic evidence of mitral prolapse had, in addition, a diastolic sound or an early diastolic murmur best heard at the apex or left sternal border. The sound, which was of high frequency and easily audible, followed A2 by 70-110 msec (mean 94 +/- 5 msec), and coincided with the point where the prolapsed posterior leaflet returned from the left atrium and recoapted with the anterior mitral leaflet. ⋯ The diastolic murmur, also of high frequency, was brief and decrescendo, and simulated aortic regurgitation in two patients. Thus, mitral prolapse may be associated with a sound or murmur in diastole. When a diastolic sound or murmur is best heard apically, even if accompanied by a systolic murmur, mitral valve prolapse should be considered.
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Three young children with anomalous origin of the left coronary artery (LCA) from the pulmonary artery were studied by two-dimensional echocardiography. The LCA was shown to be in confluence with the left posterior aspect of th pulmonary artery root in the two patients studied preoperatively. ⋯ In all, the LCA could be followed beyond the branching point. This study demonstrates the feasibility of noninvasive diagnosis of anomalous origin of the LCA from the pulmonary artery by direct visualization with two-dimensional echocardiography.