Diastolic Click in Mitral Valve Prolapse

Tsung O. Cheng, MD
Arch Intern Med. 1977;137(5):696. doi:10.1001/archinte.1977.03630170092023.
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To the Editor.—  Just about the same time when the article by Bonner et al on an early diastolic sound associated with mitral valve prolapse appeared in the Archives (136:347-349, 1976), we also encountered a patient with the prolapsing mitral leaflet syndrome with a diastolic click (Figure). To our knowledge, our patient is the fourth such reported case in the literature.1,2 Considering the frequency of the midsystolic click with or without a late systolic murmur in prolapsing mitral leaflet syndrome,3 it is surprising that the diastolic click is so infrequent. One explanation may be that the diastolic click could be mistaken as the pulmonic component of a duplicated second sound. As a matter of fact, our patient was referred to us as having an atrial septal defect with a midsystolic murmur and widely duplicated second sound. The clue that led to the correct diagnosis, which was subsequently confirmed


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