The diagnosis of mitral insufficiency is not difficult in most patients. However, determining the hemodynamic importance of an apical systolic murmur associated with mitral stenosis, aortic valvular disease, or both, is frequently difficult. Now that more patients with valvular disease are surgical candidates, the determination of each valvular abnormality is important.
Because of the poor correlation of the murmurs, X rays, and electrocardiographic findings with the degree of mitral insufficiency in patients with other valvular problems, left heart catheterization was necessary. Initially, the transseptal left heart catheterization was performed, and the left atrial and ventricular pressure curves were analyzed. However,