https://orcid.org/0000-0001-6708-0031
A 71-year-old gentleman presented to the operating theatre for an aortic valve replacement due to severe symptomatic aortic regurgitation (AR). Prior to the procedure, he was noted to have a diastolic murmur consistent with the Austin Flint murmur of severe AR. Postulated mechanisms to the aetiology of the Austin Flint Murmur include the following: the AR jet hitting the left ventricular (LV) free wall, high-frequency fluttering of the anterior mitral valve leaflet (AMVL), as well as diastolic mitral regurgitation (MR). In our patient, subsequent 2D and 3D transoesophageal echocardiography (TEE) imaging visually demonstrated the exact pathophysiological basis for this murmur. On 2D-TEE imaging and using colour flow Doppler, we can visualize a high-velocity jet projecting into the LV and hitting the inferolateral wall (Panel A, Supplementary data online, Video S1A), as well as diastolic MR (Panel A, Video S1A). M-mode imaging of the AMVL shows high-frequency fluttering of the AMVL and subsequent early closure mitral valve (Panel B). Visualizing the AMVL from the LV aspect gives us further insight into the aetiology of the Austin Flint murmur where we visualize high-frequency fluttering of the AMVL in both 2D (Supplementary data online, Video S1B) and 3D (Supplementary data online, Video S1C) views. Our TEE image and video series visually demonstrate all proposed mechanisms of the elusive Austin Flint murmur.
Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.
Conflicts of interest: F.M. receives compensation from Abbott and GE for consultation and providing educational material.
