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Valvular Heart Diseases 115

Unlike isolated aortic regurgitation where the systolic
blood pressure is very high, the systolic blood pressure
in a person with combined aortic regurgitation and
stenosis never goes above 150 mm Hg. This phenomenon
is called as ‘systolic decapitation’ of blood pressure. Also,
the pulse pressure in persons with combined lesions
is high (because of the lower diastolic blood pressure)
when compared to isolated aortic stenosis, where the
pulse pressure is usually narrow.
23. What is Gallavardin phenomenon?
Sometimes in elderly, the high frequency components of
the murmur of calcific aortic stenosis are preferentially
transmitted through the solid tissues (i.e. chest wall
and myocardium) to the apical area. This murmur,
when heard at the apical area, can be quite musical
with ‘cooving dove’ character (sometimes called as the
Gallavardin murmur). This phenomenon is called as
the ‘Gallavardin’ effect. Also, the murmur is transmitted
in such a way that it is inaudible or faint in the regions
between the aortic area and the apical area. This is
referred to as hour-glass conduction (Fig. 1).

Fig. 1: Gallavardin phenomenon with hour-glass murmur conduction