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Article
March 20, 1967

The "Murmur on Top of the Head" in Acquired Mitral Insufficiency: Pathological and Clinical Significance

Author Affiliations

From the Department of Surgery, University of Washington School of Medicine and the First University Surgical Service of the University Hospital, Seattle. Dr. Hessel is a postdoctoral fellow of the US Public Health Service.

JAMA. 1967;199(12):892-896. doi:10.1001/jama.1967.03120120080012
Abstract

A "murmur on top of the head" has been documented in seven patients with mitral insufficiency. Five patients revealed ruptured chordae tendineae of anterior leaflets secondary to rheumatic fever or subacute bacterial endocarditis. Two remaining patients exhibited rheumatic valvulitis and annular dilatation. The regurgitation was readily corrected by excising or plicating the flail area or posteromedial annuloplasty, or both. Survivors are asymptomatic without embolization or infection. Whether due to ruptured chordae of the aortic leaflet (usual) or valvulitis and annular dilatation (and in the absence of valvular calcification by fluoroscopy), the problem has been correctable by iow-risk reconstructive procedures without need for prosthetic valve replacement. Therefore, when this murmur is present, valuable inferences regarding etiology, pathology, surgical therapy, and prognosis can be made.

References
1.
Bleifer, S., et al:  The Auscultatory and Phonocardiographic Findings in Mitral Regurgitation ,  Amer J Cardiol 5:836-842 ( (June) ) 1960.Crossref
2.
Perloff, J.K., and Harvey, W.P.:  Auscultatory and Phonocardiographic Manifestations of Pure Mitral Regurgitation ,  Progr Cardiov Dis 5:172-194 ( (Sept) ) 1962.
3.
January, L.E.; Fisher, J.M.; and Ehrenhaft, J.L.:  Mitral Insufficiency Resulting From Rupture of Normal Cordae Tendineae ,  Circulation 26:1329-1333 ( (Dec) ) 1962.Crossref
4.
Kay, E.B.; Mendelsohn, D., Jr.; and Zimmerman, H.A.:  The Role of Surgery in the Treatment of Mitral Regurgitation ,  Progr Cardiov Dis 4:259-269 ( (Nov) ) 1961.Crossref
5.
Menges, H.; Ankeney, J.L.; and Hellerstein, H.K.:  The Clinical Diagnosis and Surgical Management of Ruptured Mitral Cordae Tendineae ,  Circulation 30:8-16 ( (July) ) 1964.Crossref
6.
Turrettini, G.:  De la propagation insolite et lointaine du soffle de l'insuffisance mitrale ,  Arch Mal Coeur 15:489-494 ( (July) ) 1922.
7.
Osmundson, P.J.; Callahan, J.A.; and Edwards, J.E.:  Ruptured Mitral Cordae Tendineae ,  Circulation 23:42-54 ( (Jan) ) 1961.Crossref
8.
Shapiro, H.A., and Weiss, D.R.:  Mitral Insufficiency Due to Ruptured Cordae Tendineae Simulating Aortic Stenosis ,  New Eng J Med 261:272-276 ( (Aug 6) ) 1959.Crossref
9.
Sleeper, J.C.; Orgain, E.S.; and McIntosh, H.D.:  Mitral Insufficiency Simulating Aortic Stenosis ,  Circulation 26:428-433 ( (Sept) ) 1962.Crossref
10.
Ellis, F.H., Jr.; et al:  Open Heart Surgery for Acquired Mitral Insufficiency ,  Arch Surg 79:222-236 ( (Aug) ) 1959.Crossref
11.
McGoon, D.C.:  Repair of Mitral Insufficiency Due to Ruptured Cordae Tendineae ,  J Thorac Cardiov Surg 39:357-362 ( (March) ) 1960.
12.
Berman, R.:  Ruptured Mitral Cordae Tendineae in Subacute Bacterial Endocarditis ,  J Lancet 82:48-50 ( (Feb) ) 1962.
13.
Brest, A.N.; Uricchio, J.F.; and Likoff, W.:  Traumatic Mitral Insufficiency: A Complication of Mitral Commissurotomy ,  JAMA 175:1081-1086 ( (March 25) ) 1961.Crossref
14.
Gerbode, F., et al:  Correction of Mitral Insufficiency by Open Operation ,  Ann Surg 155:846-854 ( (June) ) 1962.
15.
Kay, J.H., and Egerton, W.S.:  The Repair of Mitral Insufficiency Associated With Ruptured Chordae Tendineae ,  Ann Surg 157:351-360 ( (March) ) 1963.Crossref
16.
Steinmetz, G.P., Jr., et al:  Posteromedial Annuloplasty for Acquired Mitral Insufficiency: Methods and Results ,  Progr Cardiov Dis 5:280-297 ( (Nov) ) 1962.Crossref
17.
Askey, J.M.:  Spontaneous Rupture of Papillary Muscle of the Heart ,  Amer J Med 9:528-540 ( (Oct) ) 1950.Crossref
18.
Edwards, J.E., and Burchell, H.B.:  Endocardial and Intimal Lesions (Jet Impact) as Possible Sites of Origin of Murmurs ,  Circulation 18:946-960 ( (Nov) ) 1958.Crossref
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