Noninvasive detection of aortic insufficiency in patients with mitral stenosis by pulsed Doppler echocardiography.

In patients with mitral stenosis, routine noninvasive techniques are insensitive for the detection of coexistent aortic insufficiency. The ability of pulsed Doppler echocardiography to detect the presence or absence of angiographically demonstrated aortic insufficiency was evaluated in 45 patients with rheumatic mitral stenosis. Pulsed Doppler echocardiography correctly identified the presence of aortic insufficiency in 97% of the 35 patients with documented aortic regurgitation. More important, pulsed Doppler echocardiography disclosed aortic insufficiency in all 7 patients in whom it was not suspected on physical examination and in 28 of the 29 patients in whom it was not suspected by M-mode echocardiography. Pulsed Doppler echocardiography also demonstrated excellent specificity, correctly detecting the absence of aortic insufficiency in 9 of the 10 patients who had no angiographic evidence of aortic insufficiency. It is concluded that in patients with mitral stenosis, pulsed Doppler echocardiography is a useful noninvasive diagnostic test for evaluating the presence of aortic insufficiency, even when this lesion is not detectable by physical examination or M-mode echocardiography.