Atypical systolic clicks produced by prolapsing mitral valve masses

Alan J. Bank, Scott W. Sharkey, Steven R. Goldsmith, David M. Salerno, Richard W. Asinger

Research output: Contribution to journalArticlepeer-review


Mid- or late-systolic clicks were originally thought to be extracardiac in origin.1 It was not until the 1960s that these clicks were demonstrated by angiography to be associated with late systolic prolapse of the mitral valve and mitral regurgitation.2 This was subsequently confirmed by intracardiac phonocardiographic recording of clicks and late systolic murmurs in the left (but not the right) atrium.3 Since that time, occasional cases of mid- and late-systolic sounds have been described in the absence of mitral valve prolapse. These include a left ventricular tumor prolapsing into the left atrium,4 a right ventricular tumor prolapsing across the pulmonic valve,5 right atrial myxomas "plopping" in and out of the right ventricle,6 severe aortic regurgitation7 and prolapse of the tricuspid valve.8 The present report reviews a previous case we described of a midsystolic click produced by a prolapsing prosthetic mitral valve vegetation9 and describes 2 additional cases of atypical midsystolic clicks associated with prolapsing mitral valve masses. We propose that the mechanism of sound production was the same in all 3 cases and was associated with abrupt movement of a mitral leaflet toward the left ventricle during "disengagement" of the mass from the mitral valve apparatus, and prolapse into the left atrium.

Original languageEnglish (US)
Pages (from-to)1491-1494
Number of pages4
JournalThe American Journal of Cardiology
Issue number17
StatePublished - Jun 1 1992


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