Unilateral Pulmonary Edema in Patients With Acute Mitral Regurgitation Caused by Chordal Rupture

Abstract

Chikamori Hospital during a 15-year period between 2006 and 2020. The initial evaluation in the present study was regarded as the first clinical assessment during which an echocardiographic diagnosis of chordal rupture and significant MR was made. From the 143 consecutive patients, 38 who had an initial chest radiographic examination within 72 h of the onset of symptoms were enrolled in the present study. All 38 patients underwent clinical evaluation at the time of admission and received appropriate and best possible management during hospitalization. The characteristics of patients with UPE were compared with those of patients with bilateral pulmonary edema (BPE). DefinitionsChordal Rupture and Acute MR The diagnosis of chordal rupture and MR was based on transthoracic echocardiographic and color Doppler echocardiographic identification of ruptured chordae, leaflet prolapse, and significant MR. 10 The diagnosis was made at the time of admission. Unilateral pulmonary edema (UPE), localized to the right upper lobe, is known as an unusual condition 1-5 and was reported to represent 2.1% of cardiogenic pulmonary edemas in a previous study. 1 Cardiogenic UPE has been reported, mostly in sporadic case reports, in association with severe mitral regurgitation (MR). 1,2,6-9 An eccentric direction of the MR jet is considered responsible for this unusual radiographic finding. 9However, the prevalence of UPE in patients with severe MR remains unknown. Therefore the aim of the present study was to determine the prevalence and characteristics of UPE, specifically in patients with severe MR caused by chordal rupture. Methods Study PopulationThis study enrolled 143 consecutive patients with chordal rupture and significant MR who were hospitalized at

Mitral regurgitation in the critically ill: the devil is in the detail

“…These cases present with acute features of pulmonary oedema and possibly haemodynamic instability with echocardiographic findings suggestive of chronic MR (e.g. LA/LV dilation) [ 35 – 37 ]. In such cases, reviewing previous imaging or performing TOE can help to identify new structural changes.…”