Following are the proposed mechanisms for the mid diastolic murmur in mitral area in severe aortic regurgitation:
Fluttering of the anterior mitral leaflet due to the regurgitant jet impinging on it
Jet can produce relative narrowing of the mitral orifice
Elevation of left ventricular diastolic pressure causes the mitral valve to float back to a partially closed position
Diastolic mitral regurgitation due to elevated left ventricular diastolic pressure