Rapid high-frequency fluttering of anterior mitral valve leaflets during systole on 2D ECHO is characteristically seen with

Echocardiogram in aoic regurgitation:In chronic aoic regurgitation (AR), the LV size is increased and systolic function is normal or even supernormal until myocardial contractility declines.A rapid, high-frequency diastolic fluttering of the anterior mitral leaflet produced by the impact of the regurgitant jet is a characteristic finding.The echocardiogram is also useful in determining the cause of AR, by detecting dilation of the aoic annulus and root, aoic dissection or primary leaflet pathology. With severe AR, the central jet width assessed by color flow Doppler imaging exceeds 65% of the left ventricular outflow tract, the regurgitant volume is >=60 mL/beat, the regurgitant fraction is >=50%, and there is diastolic flow reversal in the proximal descending thoracic aoa. Surveillance transthoracic echocardiography forms the cornerstone of follow-up and allows for the early detection of changes in LV size and/or function. On auscultation, in patients with severe AR, a low-pitched, rumbling mid-to-late diastolic murmur is heard at the apex. This is called the Austin Flint murmur. It is probably produced by the diastolic displacement of the anterior leaflet of the mitral valve by the AR stream.It may be mistaken for MS but can be differentiated from MS murmur because the Austin Flint murmur is not intensified in presystole and becomes softer with the administration of amyl nitrite.Ref: Harrison's 18/e p1944, 1931