WILLIAM C. REEVES, M.D.
To the editor: I enjoyed the recent review article on auscultation of the normally functioning prosthetic valve by Smith and colleagues (1). Several points, however, need clarification.
The authors mention that ball valves in the mitral area normally
have an apical early to mid-systolic murmur at the lower left sternal border. They note in their Figure 2 that this is a grade 2 to 3/6 systolic ejection murmur. The references quoted to support this statement do not address this question. But in a later reference (2), an ejection mid-systolic murmur at the apex is said to occur in most persons
REEVES WC. The Normally Functioning Prosthetic Valve. Ann Intern Med. ;97:144–145. doi: 10.7326/0003-4819-97-1-144_2
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Published: Ann Intern Med. 1982;97(1):144-145.
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