The Loudness Of The Opening Snap

1. Other than an obese or emphysematous chest and AR, what can cause a soft or absent OS despite significant MS?

ANS: a. The mitral valve may be too calcified for the bellies to snap to their maximal open position. (The S1 may still be loud.) b. Extremely low flow due to exceptional severity of the stenosis, secondary pulmonary hypertension, concomitant aortic or tricuspid valve disease, or myocardial dysfunction.

2. How often does a mitral commissurotomy eliminate the OS?

ANS: Probably in not more than half the cases.

Aortic And With Opening Snap

Aortic curve at high pressure

Aortic curve at low pressure

LV pressure curve

L. atrial pressure in mitral stenosis

Note that the higher the aortic pressure the longer the A2-OS interval.

Note: Normally, a porcine valve may produce a soft OS in two-thirds of patients. The presence or absence of an OS reveals nothing about porcine valve malfunction [1].

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