Stenosis of the left atrioventricular holes and aortic valve insufficiency

This combination occurs quite often. According to G. I. Dekhtyar (1966), the combination of mitral stenosis with aortic insufficiency is about 80% of all combined defects in adults. Recognition of this combination usually does not cause trouble.
With this combination at the apex of the heart defines a typical melody mitral stenosis: clapping I tone high tone, emphasis and splitting II tone of the pulmonary artery. Along with this 5-th point and at the base of the heart are heard typical diastolic aortic noise. A number of patients detected and other distinctive signs of aortic insufficiency such as the rapid and high pulse, low minimum blood pressure, throbbing neck vessels and other
If the clinical picture of Vice prevails stenosis of the left atrioventricular holes, the result of increase of pressure in the pulmonary circulation is the extension of the initial part of the pulmonary artery that leads to the relative failure of its valve. Thus in the second intercostal space on the left are heard and diastolic murmur, which by its nature is no different from noise heard in aortic insufficiency.
The availability of this combination of defect is confirmed by the characteristic changes in the electrocardiogram: along with evidence of left ventricular hypertrophy on the electrocardiogram clearly visible signs of hypertrophy of the left atrium and right ventricle. While in II standard lead prong P broad, low, split (P-mitrale). In the left chest leads (V1 and V2) form his dwuhfazno. In these leads (V1 and V2) are showing signs of hypertrophy of the right ventricle to the form of the QRS complex type R-S (M, Santucci and, Bono, 1966). May be signs of diastolic overload of the left ventricle. Electrical axis of heart, however, may not be modified or deviate to the right (Fig. 28).
A certain value in the diagnosis of this combination has phonocardiographic study. On phonocardiogram revealed the characteristic features of mitral stenosis (increase in the amplitude of the first tone, lengthening of the interval Q-I tone, splitting II tone pulmonary artery, a "click" open mitral valve) and protohistorical Crescent shaped noise, the sternum, characteristic of stenosis of the left atrioventricular holes.
The data of x-ray studies also point to a combination of Vice.