To evaluate the relation between left ventricular angiography and pulmonary venous flow velocity in native mitral valve regurgitation, 28 patients with sinus rhythm and valvular and/or coronary artery disease underwent transesophageal echocardiography within 24 hours after cardiac catheterization. Group I consisted of 17 patients, seven patients without (grade 0) and 10 patients with angiographically mild to moderate mitral regurgitation (grades 1 and 2). Group II consisted of 11 patients with angiographically severe mitral regurgitation (grades 3 and 4). Mitral regurgitation by transesophageal echocardiography was evaluated by measuring the regurgitant jet sizes and color-guided pulsed Doppler pulmonary venous flow velocities. Multivariate analysis revealed that the most powerful predictor (p less than 0.001) of angiographically severe (grades 3 and 4) mitral regurgitation was reversed systolic flow into the left upper pulmonary vein (sensitivity 82%, specificity 100%, positive predictive value 100%). If this variable was excluded from analysis, jet area and jet length (p less than 0.001) were the next best predictors for angiographically severe mitral regurgitation. Mean values of systolic peak pulmonary venous flow velocities were significantly lower in patients from group II, 13.0 +/- 11.1 cm/s versus 43.4 +/- 20.6 cm/s (group I) with p less than 0.005. This finding was also true for systolic time velocity integral, 1.3 +/- 1.3 cm (group II) versus 7.8 +/- 5.3 cm (group I) with p less than 0.005.(ABSTRACT TRUNCATED AT 250 WORDS)