Hemodynamic prerequisites for the occurrence of diastolic mitral valve regurgitation

Sochanski, Mirek; Lang, Roberto M.; Weinert, Lynn; Bednarz, J.; Neumann, Alex; Ehler, Donna; David, Daniel

doi:10.1016/0002-9149(93)90619-n

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…1 It can be best documented with continuous wave Doppler spectral display. Most often it has been shown to be related to poor LV function and regional mechanical dyssynchrony with atrio-ventricular block of different grades.…”

Section: Discussionmentioning

confidence: 99%

Diastolic Regurgitation Through a Bi-Leaflet Mechanical Valve in the Mitral Position

Konia

Uppington

2008

Anesthesia &Amp; Analgesia

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Jeffrey Uppington, MB, BS, FRCA A64-yr-old man presented for aortic valve replacement due to worsening aortic insufficiency (AI) associated with left ventricular (LV) dilation. He had a history of mitral valve replacement with a bi-leaflet mechanical St. Jude's valve 15 yr before this surgery. Preoperative transthoracic echocardiography showed 3-4ϩ AI and mitral regurgitation (MR) estimated to be 3ϩ. The ejection fraction was assessed as 60%. Cardiac catheterization demonstrated no significant coronary artery disease, AI 3-4ϩ, MR 1ϩ and an ejection fraction of 40%.Aortic valve replacement with possible aortic root replacement was planned. An intraoperative precardiopulmonary bypass transesophageal echocardiogram was requested by the surgeon to examine the mechanical mitral valve for signs of significant regurgitation requiring surgical treatment.During intraoperative transesophageal echocardiogram, the aortic valve was evaluated in the midesophageal aortic valve short-axis view and midesophageal aortic valve long-axis view. The right and noncoronary cusp of the aortic valve were thin and stretched and were prolapsing into the LV outflow tract. Central edges of the leaflets were thickened and mildly retracted with focal areas of calcification. The AI jet was eccentric, directed towards and under the mitral valve leaflets. It was estimated as 3-4ϩ based on over 6 mm width of the vena contracta, AI height/LV outflow tract diameter ratio of 70% and holosystolic retrograde flow in the descending aorta.The bi-leaflet prosthetic mitral valve leaflets could be well visualized in the midesophageal four-chamber view and appeared to be moving well and symmetrically. Color Doppler examination of the mitral valve in different midesophageal views demonstrated MR estimated as 1-2ϩ. On careful examination, we were able to distinguish systolic regurgitant jets consistent with expected mechanical valve backflow (washing jets) (Fig.

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Section: Discussionmentioning

confidence: 99%

Diastolic Regurgitation Through a Bi-Leaflet Mechanical Valve in the Mitral Position

Konia

Uppington

2008

Anesthesia &Amp; Analgesia

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“…Diastolic mitral valve regurgitation (MR) is a rare phenomenon described in patients with atrioventricular conduction abnormalities, 1 severe left ventricular (LV) systolic or diastolic dysfunction with regional wall motion dyssynchrony, or severe acute aortic valve regurgitation. 2,3 The presence of diastolic MR in acute aortic regurgitation due to endocarditis suggests critical severity requiring urgent surgical valve replacement. 4 We describe a case of diastolic mitral regurgitation in the setting of complex native mitral-aortic valve endocarditis in a patient in normal sinus rhythm and review the etiologic mechanisms of this phenomenon, echocardiographic assessment, and therapeutic implications for hemodynamic management.…”

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confidence: 99%

Diastolic Mitral Regurgitation in a Patient With Complex Native Mitral and Aortic Valve Endocarditis

Pulido

Lynch

Mauermann

et al. 2015

Semin Cardiothorac Vasc Anesth

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Diastolic mitral valve regurgitation is a rare phenomenon described in patients with atrioventricular conduction abnormalities, severe left ventricular systolic or diastolic dysfunction with regional wall motion dyssynchrony, or severe acute aortic valve regurgitation. The presence of diastolic mitral valve regurgitation in acute aortic regurgitation due to endocarditis suggests critical severity requiring urgent surgical valve replacement. We describe a case of diastolic mitral regurgitation in the setting of complex native mitral-aortic valve endocarditis in a patient in normal sinus rhythm and review the etiologic mechanisms of this phenomenon, echocardiographic assessment, and therapeutic implications for hemodynamic management.

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Abnormal left ventricular filling after neonatal repair of congenital heart disease: Association with increased mortality and morbidity

Li¹,

Bengur²,

Ungerleider³

et al. 1998

American Heart Journal

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Hemodynamic prerequisites for the occurrence of diastolic mitral valve regurgitation

Cited by 5 publications

References 6 publications

Diastolic Regurgitation Through a Bi-Leaflet Mechanical Valve in the Mitral Position

Diastolic Regurgitation Through a Bi-Leaflet Mechanical Valve in the Mitral Position

Diastolic Mitral Regurgitation in a Patient With Complex Native Mitral and Aortic Valve Endocarditis

Abnormal left ventricular filling after neonatal repair of congenital heart disease: Association with increased mortality and morbidity

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