Opening Snap in the Absence of Mitral stenosis

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Rarely, excessive flow across the mitral valve in certain clinical conditions can be associated with the presence of an OS associated with the opening of the mitral valve in the absence of mitral stenosis. These include pure mitral regurgitation, ventricular septal defect, persistent ductus arteriosus, tricuspid atresia with large atrial septal defect, and thyrotoxicosis (54-56). In atrial septal defect, the torrential flow across the tricuspid valve may be associated with a tricuspid OS (56).

Fig. 27. (A) Diagram showing simultaneous left ventricular (LV) and left atrial (LA) pressures in mild, moderate, and severe degrees of mitral stenosis. The more severe the stenosis, the higher will be the left atrial pressure. The opening snap (OS) occurs at the end of the isovolumic relaxation phase of the left ventricle when the left ventricular pressure falls just below the left atrial pressure. The OS will therefore tend to occur earlier with higher LA pressure and later with lower LA pressure. Thus, the S2-OS interval is short with severe mitral stenosis and long with mild mitral stenosis. (B) Visual representation of the excursion of the mitral leaflets in mitral stenosis of different degrees of severity: a, normal; b, mild; c, moderate; d, severe. With milder stenosis the column of blood has to travel further before deceleration against the valve, thereby making a late OS.

Fig. 27. (A) Diagram showing simultaneous left ventricular (LV) and left atrial (LA) pressures in mild, moderate, and severe degrees of mitral stenosis. The more severe the stenosis, the higher will be the left atrial pressure. The opening snap (OS) occurs at the end of the isovolumic relaxation phase of the left ventricle when the left ventricular pressure falls just below the left atrial pressure. The OS will therefore tend to occur earlier with higher LA pressure and later with lower LA pressure. Thus, the S2-OS interval is short with severe mitral stenosis and long with mild mitral stenosis. (B) Visual representation of the excursion of the mitral leaflets in mitral stenosis of different degrees of severity: a, normal; b, mild; c, moderate; d, severe. With milder stenosis the column of blood has to travel further before deceleration against the valve, thereby making a late OS.

Congenital mitral stenosis is not usually associated with OS because these valves are abnormal and not pliable.

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