TIME RELATIONSHIPS OF THE LEFT ATRIAL V WAVE IN MITRAL VALVULAR DISEASE BY

Blood flowing into the left atrium during ventricular systole causes an increase in pressure known as the "v " wave. From the apex of the "v " wave pressure declines in the "y " descent. Diagnostic formulk have been based upon the assumption that the summit of the "v " wave marks the opening of the mitral valve and the whole of the "y " descent represents atrial emptying. This hypothesis is not consistent with the observation that the "v " peak may occur earlier, even before the aortic valve has closed (Luisada and Liu, 1959; Rich, 1959). The purpose of this communication is to examine the relationship of the left atrial "v " peak to aortic valve closure and mitral opening in patients disabled from chronic rheumatic heart disease. MATERIAL AND METHODS Eighteen patients disabled from chronic rheumatic mitral valvulitis were selected for study on the grounds of their freedom from evidence of hypertensive, ischemic, and aortic valvular disease. Each was examined clinically, cardiographically, and radiologically. In ten the mitral valve was examined at valvotomy or open-heart operation by Mr. G. H. Wooler. The left heart was catheterized through the fossa ovalis (Ross, 1959) in the manner described by Nixon 1960(a). Indicator dilution curves were obtained by injecting blue dye into the left atrium