Complete resolution of diastolic mitral regurgitation in chronic, but not acute aortic regurgitation after aortic valve replacement--a transesophageal echocardiography study.

A 65-year-old male was admitted with progressive dyspnea on exertion. Severe aortic regurgitation (AR) had been disclosed by transthoracic echocardiography 10 mon previously. Aortic valve replacement was proposed and intraoperative transesophageal echocardiography on color Doppler imaging revealed severe aortic regurgitation, moderate global hypokinesis of the left ventricle and mild-to-moderate diastolic mitral regurgitation. The regurgitant jet was seen to pass through the posterior mitral leaflet in a direction toward the center of left atrium. Mitral valve perforation was suspected. But mitral valve was found to be intact after a thorough exploration. Surgery proceeded uneventfully and diastolic mitral regurgitation was resolved completely after the aortic valve was successfully replaced. Diastolic mitral regurgitation has been reported to be closely related to acute AR, but the picture differs somewhat from the present example. The possible cause for this disease presentation is to be further investigated.