Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation

Abstract

Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH.

A rare cause of diffuse alveolar hemorrhage: dissection of aorta

“…Akut mitral kapak regürjitasyonu gibi acil kardiyak patolojilere bağlı DAH olguları bildirilmiştir. [4] İlginç olarak epileptik atağa bağlı intratorasik basınç artışı ile ilişkili DAH olguları da bildirilmiştir. [5] Bu durumlarda akciğerlere doğru hızlı ve yüksek geri kan akımı olmakta ve bunun sonucunda pulmoner kapiller basınçta ani ve yüksek bir artış meydana gelmektedir.…”

“…Bu durum sıklıkla transkapiller alandan sıvı sızması ile pulmoner ödeme neden olur iken aynı zamanda bu kapiller basınç artışı alveoler septal bariyerde yapısal değişikliklere ve permeabilite artışı ile alveoler hemorajilere neden olur. [4,5] Bizim olgumuzda da benzer mekanizmalar ile önce ani ve yüksek pulmoner kapiller basınç artışı ve buna bağlı pulmoner ödem ve sonrasında alveoler septal bariyerde yapısal bozulma ve permeabilite artışı ile DAH geliştiğini düşünüyoruz.…”

Unilateral cardiogenic pulmonary edema associated with acute mitral regurgitation

“…Unilateral cardiogenic pulmonary edema is often misdiagnosed as pneumonia, aspiration, or alveolar hemorrhage 4. The mortality rate of unilateral pulmonary edema is twice as high as that of bilateral pulmonary edema due to initial misdiagnosis and delayed treatment 3, 5. Physicians should promptly diagnose to avoid delays in treatment.…”

“…This is an unusual symptom of acute decompensated heart failure 5, 6. There is a possible reason for hemoptysis in acute mitral regurgitation; the hemodynamic state in acute mitral regurgitation changes more rapidly than in chronic mitral regurgitation, therefore, the time for the left atrium to adapt is short 7.…”

“…There is a possible reason for hemoptysis in acute mitral regurgitation; the hemodynamic state in acute mitral regurgitation changes more rapidly than in chronic mitral regurgitation, therefore, the time for the left atrium to adapt is short 7. As a result, an abrupt pressure elevation within the left atrium reflects back into the pulmonary circulation, leading to blood leakage from the capillaries 5, 6…”