We agree with Dr Manning that the absence of a prominent v wave on the pulmonary wedge tracing, as well as the absence of a loud murmur, is not sufficient to rule out acute severe mitral regurgitation. In our seven patients with this entity, five of seven did not have loud murmurs on auscultation, and two of five in whom Swan-Ganz catheters were placed did not have large v waves.We feel that echocardiography is much more useful than Swan-Ganz catheterization in determining the presence of a mechanical complication following myocardial infarction. If a rupture of a papillary muscle or a ventricular septal defect cannot be directly visualized by two-dimensional echocardiography, the diagnosis is established; hence, a ventriculogram is not required.1 Even if the papillary muscle or a ventricular septal defect can be directly visualized, the presence of a hyperdynamic left ventricle in the setting of pulmonary
Nishimura RA, Schaff HV, Gersh BJ, Holmes DR, Tajik AJ. Early Repair of Mechanical Complications After Acute Myocardial Infarction-Reply. JAMA. 1986;256(20):2816. doi:10.1001/jama.1986.03380200054011
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