Systolic mitral flutter, an echocardiographic clue to the diagnosis of ruptured chordae tendineae.

A new finding of fine systolic fluttering of the mitral leaflet is described in two patients with ruptured chordae tendinease and severe mitral regurgitation. The flutter is caused by the action of high-velocity blood flow upon the leaflet margin that has lost its support. The jet stream of blood evokes a high-frequency vibratory motion of the tensed leaflet as opposed to the previously described, lower frequency, less specific, diastolic flutter. This finding was not seen in the echocardiograms of 75 patients with other forms of mitral regurgitation. Systolic flutter appears to be specific for ruptured chordae tendineae.