A4

The correct answer is D, Aortic regurgitation. The M-mode illustrates fluttering or vibration of the mitral valve leaflets. This occurs in diastole when the jet of aortic regurgitation hits the anterior leaflet of the mitral valve. Note that fluttering of the mitral leaflets is not correlated with severity of aortic regurgitation. However, early MV closure is suggestive of severe aortic regurgitation. Mitral stenosis is accompanied by left atrial enlargement, thickened mitral valve leaflets and a reduced E-F slope. Left ventricular outflow tract obstruction would have mid systolic closure of the aortic valve due to obstruction in the LVOT. A mitral valve vegetation would be a mobile mass on the mitral leaflets and may appear in the mitral valve orifice, moving in random fashion.