Diagnosis of mitral valve diseases using indirect (esophageal) left atrial pulse

The diagnostic usefulness of the indirect (esophageal) left atrial pulse (ESO) has been analyzed in: 1) 25 patients (pts) with mitral insufficiency (MI), 2) 18 pts with mitral stenosis, 3) 29 pts with combined valvular disease, 4) 10 normal subjects. In addition, in 1) and 4), the ESO was recorded under the following dynamic conditions: a) during isometric exercise (handgrip), b) after inhalation of amyl nitrite, c) after intravenous infusion of methoxamine. The ESO tracing demonstrated estimates of the severity of the disease. Under dynamic conditions no modification from the resting morphology was obtained in the control group, whereas in MI the following modifications were observed: a) increased, progressive, positive elevation of the systolic phase of the ESO during the handgrip and the administration of the methoxamine; b) tendency to return to normal morphology after amyl nitrite