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Seagulls flying in the echo lab
  1. S Mondillo,
  2. P Ballo,
  3. V Zacà

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A “seagull’s cry murmur” is defined as a murmur imitating the cooing sound of a seagull. This type of murmur is typically characterised by a musical timbre and a high frequency, and may occur as a result of various valve diseases. It is usually described as a sign of tight calcific aortic stenosis, when the murmur’s high frequency components are transmitted to the lower left sternal border and the cardiac apex during most of systole (Gallavardin’s phenomenon). In this condition, the typical harsh timbre of the ejective murmur tends to assume a musical high pitched quality, resembling that of mitral regurgitation, which may be reminiscent of the cry of a seagull. A protodiastolic murmur with similar characteristics, typically in decrescendo, may occur in severe aortic valve regurgitation, particularly when the regurgitant flow presents high velocities. However, a seagull’s cry murmur may also be the sign of mitral regurgitation or prolapse. Similarly, the musical and holosystolic sound reflects the presence of high frequency components due to high velocities of reflow. This image represents the pulsed Doppler pattern of mitral flow, obtained in a subject with mitral regurgitation. Curiously, in the context of this mitral regurgitation spectrum, as obtained by continuous Doppler, seagull’s stylised images are reproduced. This appearance of multiple winged signs refers to the presence of high frequency components and harmonics that are likely to be caused by ruptured chordae tendinae.

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