Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

Güvenç, Rengin Çetin; Güvenç, Tolga Sinan

doi:10.1016/j.joad.2015.11.001

Cited by 11 publications

(13 citation statements)

References 47 publications

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“…Previous reports have demonstrated a sensitivity ranging between 65% and 85% for TTE. 17,18 Transesophageal echocardiography remains the modality of choice for evaluation of the mitral valve with a diagnostic yield between 95% and 100%. 18 Recent reports have suggested that 3D echocardiography might help in the diagnosis and surgical management of PMR.…”

Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic presentation of postmyocardial infarction papillary muscle rupture

et al. 2019

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Background Severe mitral regurgitation (MR) can occur following myocardial infarction (MI) with either partial or complete papillary muscle rupture (pPMR or cPMR). Although the incidence of this complication has significantly decreased, it is still associated with significant mortality. We sought to evaluate the different echocardiographic and clinical presentations of pPMR and cPMR. Methods and Results A review of all the urgent procedures for ischemic MR between January 2000 and June 2016 was performed to identify patients who underwent surgery for PMR. Surgical protocols and echocardiographic studies were used to identify patients with cPMR and pPMR. A total of 37 patients had cardiac surgery for PMR (18 cPMR, 19 pPMR). All patients with cPMR were in cardiogenic shock at the time of diagnosis, as opposed to only 53% of patients with pPMR (P = 0.0008). Between the time of diagnosis and surgery, 7 patients with pPMR developed cardiogenic shock. Transthoracic echocardiography (TTE) led to the diagnosis in 72% of cPMR and 32% of pPMR (P = 0.02). TEE had a yield of 100% for both cPMR and pPMR. Six pathologic varieties of post‐MI PMR were recognized on echocardiography and during surgery. Early postoperative, 1 (72% vs 84%), 3 (67% vs 84%), and 5 years (67% vs 74%) survival rates were similar for cPMR and pPMR (P = 0.26). Conclusions Partial PMR is associated with a different clinical and echocardiographic presentation than cPMR. Still, most pPMR patients progress toward cardiogenic shock. Prompt diagnosis and referral for surgery are critical and could potentially decrease mortality.

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Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic presentation of postmyocardial infarction papillary muscle rupture

et al. 2019

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Section: Pathophysiologymentioning

confidence: 99%

“…The two processes that have been associated with the development of ischaemic MR following papillary dysfunction/rupture include (1) the disruption of the coronary blood flow and (2) changes in the left ventricular geometry [ 18 , 25 , 26 ]. The anterior papillary muscle (ALPM) is subtended by both the left anterior descending (LAD) and left circumflex artery (LCx), and is thus less vulnerable to ischaemia [ 25 ]. The posteromedial papillary muscle (PMPM) is supplied only by the posterior descending artery (PDA) with its long intramyocardial trajectory, and is thus more susceptible to ischaemia and rupture [ 25 , 27 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…The anterior papillary muscle (ALPM) is subtended by both the left anterior descending (LAD) and left circumflex artery (LCx), and is thus less vulnerable to ischaemia [ 25 ]. The posteromedial papillary muscle (PMPM) is supplied only by the posterior descending artery (PDA) with its long intramyocardial trajectory, and is thus more susceptible to ischaemia and rupture [ 25 , 27 ]. It has been reported that either complete or partial rupture of the posteromedial papillary muscle occurs between 6× and 12× more frequently because of its coronary blood supply [ 25 , 28 , 29 ].…”

Section: Pathophysiologymentioning

confidence: 99%

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Acute Ischaemic Mitral Valve Regurgitation

Hennessey

Sabatovicz²,

Trigo

2022

JCM

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Acute ischaemic mitral regurgitation (IMR) is an increasingly rare and challenging complication following acute myocardial infarction. Despite recent technical advances in both surgical and percutaneous interventions, a poor prognosis is often associated with this challenging patient cohort. In this review, we revisit the diagnosis and typical echocardiographic features, and evaluate current surgical and percutaneous treatment options for patients with acute IMR.

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“…Symptoms usually develop over time with the progression of left ventricle worsening due to the left ventricle can't compensate for the volume overload or increase in the effective orifice area. [1] Management of Mitral Valve Regurgitation is focused primarily on the repairment of Mitral Valve by surgical procedure, either in asymptomatic or symptomatic patients. [2] As in the deprived socioeconomic population, this is not always the case.…”

Section: Introductionmentioning

confidence: 99%

Progression and Challenges of Medical Treatment in Severe Functional Mitral Regurgitation: Case Report of 41-Year-Old Woman

2019

ARC Journal of Clinical Case Reports

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Introduction: The management of Mitral Regurgitation that still focuses heavily on surgical procedure, proves a challenge in deprived socioeconomic status. Case Presentation: We report a case of an asymptomatic forty-one years old woman referred with severe mitral regurgitation. Initial echocardiography shows that the patient has a severe mitral regurgitation. Later she underwent serial of follow-up echocardiography while administered oral medications for three months. In the latest evaluation she was found to have a significant improvement in lesion. Discussion: Despite the promising result, there is a challenge in early surgical intervention because of the limitation in experienced and advanced surgical centre as a prerequisite. When an adequate facility isn't available, medical treatment could help with the management of the valve insufficiency. However, there is still limited studies regarding the benefit of long-term medical therapy in severe valve insufficiency. Conclusion: Medical therapy for mitral regurgitation could play a role in a setting where an adequate surgical facility is not available and watchful-waiting approach is assigned to the patient.

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Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

Cited by 11 publications

References 47 publications

Clinical and echocardiographic presentation of postmyocardial infarction papillary muscle rupture

Clinical and echocardiographic presentation of postmyocardial infarction papillary muscle rupture

Acute Ischaemic Mitral Valve Regurgitation

Progression and Challenges of Medical Treatment in Severe Functional Mitral Regurgitation: Case Report of 41-Year-Old Woman

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