Diastolic Click in Mitral Prolapse

David H. Schoening, MD; Jerry F. Meyer, MD
Arch Intern Med. 1977;137(4):544. doi:10.1001/archinte.1977.03630160100030.
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To the Editor.—  We read with interest the recent report by Bonner et al in the Archives (136:347-349, 1976), which detailed a case of mitral prolapse with a diastolic click. Using simultaneous echocardiographic and apexcardiographic recordings, they demonstrated that the diastolic click occurred with the echocardiographic mitral valve "D" point and well before the apexcardiographic "0" point. They theorized that the diastolic click was produced by initial diastolic acceleration of the prolapsed mitral leaflets.We have recently observed a 34-year-old woman with late systolic and early diastolic clicks in whom pansystolic prolapse was diagnosed by echocardiography. Simultaneous echocardiographic, phonocardiographic, and apexcardiographic recordings showed the diastolic click to coincide with the echocardiographic "E" point and the apexcardiographic "0" point (Figure). In this case, the diastolic click occurred when the mitral leaflets were fully open, rather than at the initiation of diastolic mitral valve motion, suggesting it is analogous to an opening


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