Three cases of severe mitral incompetence after heterograft aortic valve replacement are described. In all cases an early third heart sound was recorded on the phonocardiograms. In two cases a prominent early diastolic peak was also recorded on the apex cardiograms. These findings do not support the widely held view that the third heart sound is produced by sudden tautening of the mitral valve structures during the rapid filling phase of the left ventricle.
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