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Presence of AI - aortic incompetence will result in a rapid rise in LV diastolic pressure, limiting the gradient across the mitral valve during diastole.
There are many other more common causes of aortic incompetence, including rheumatic fever, but cases of syphilitic aortic-valve disease still turn up from time to time in this country, albeit rarely.
While the death certificate indicates that Peter Mackenzie-Richards died of "Aortic Incompetence", "Pulmonary Congestion", and "Hepatic Congestion", family tradition suggests his death was as a result of the Spanish flu.
The reason for surgical repair of Type A dissections is that ascending aortic dissections often involve the aortic valve, which, having lost its suspensory support, telescopes down into the aortic root, resulting in aortic incompetence.