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Mitral Regurgitation

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Clinical Cases in Cardiology

Abstract

A 68-year-old man is referred to his family doctor for dyspnea and fatigue for ordinary activities; symptoms arose 3 months before. At the beginning, dyspnea was mild and was present only after a moderate to intense physical activity. In the last 2 weeks, the symptoms worsened until dyspnea was evident during moderate physical activity (fast walking or after few steps of stairs) with even one episode of orthopnea at night that resolved after 30 min. No chest pain at rest or during exertion was referred; there were no syncope or dizziness and no palpitations.

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References

  1. Kumanohoso T, Otsuji Y, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, Minagoe S, Levine RA, Tei C (2003) Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 125:135–143

    Article  PubMed  Google Scholar 

  2. Otto CM (2001) Evaluation and management of chronic mitral regurgitation. N Engl J Med 345:740

    Article  CAS  PubMed  Google Scholar 

  3. Marcus RH, Sareli P, Pocock WA, Barlow JB (1994) The spectrum of severe rheumatic mitral valve disease in a developing country. Correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. Ann Intern Med 120:177–183

    Article  CAS  PubMed  Google Scholar 

  4. Tibayan FA, Rodriguez F, Zasio MK, Bailey L, Liang D, Daughters GT, Langer F, Ingels NB, Miller DC (2003) Geometric distortions of the mitral valvular-ventricular complex in chronic ischemic mitral regurgitation. Circulation 108(Suppl 1):II116–II121

    PubMed  Google Scholar 

  5. Izumi S, Miyatake K, Beppu S et al (1987) Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography. Circulation 76:777–785

    Article  CAS  PubMed  Google Scholar 

  6. Yellin EL, Yoran C, Sonnenblick EH, Gabbay S, Frater RW (1979) Dynamic changes in the canine mitral regurgitant orifice area during ventricular ejection. Circ Res 45:677–683

    Article  CAS  PubMed  Google Scholar 

  7. Enriquez-Sarano M, Seward JB, Bailey KR, Tajik AJ (1994) Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept. J Am Coll Cardiol 23:443–451

    Article  CAS  PubMed  Google Scholar 

  8. Yoran C, Yellin EL, Becker RM, Gabbay S, Frater RW, Sonnenblick EH (1979) Dynamic aspects of acute mitral regurgitation: effects of ventricular volume, pressure and contractility on the effective regurgitant orifice area. Circulation 60:170–176

    Article  CAS  PubMed  Google Scholar 

  9. Keren G, Bier A, Strom JA, Laniado S, Sonnenblick EH, LeJemtel TH (1986) Dynamics of mitral regurgitation during nitroglycerin therapy: a Doppler echocardiographic study. Am Heart J 112:517–525

    Article  CAS  PubMed  Google Scholar 

  10. Braunwald E, Awe WC (1963) The syndrome of severe mitral regurgitation with normal left atrial pressure. Circulation 27:29–35

    Article  CAS  PubMed  Google Scholar 

  11. Enriquez-Sarano M, Tajik AJ, Schaff HV et al (1994) Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol 24:1536–1543

    Article  CAS  PubMed  Google Scholar 

  12. Crawford MH, Souchek J, Oprian CA et al (1990) Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease. Circulation 81:1173–1181

    Article  CAS  PubMed  Google Scholar 

  13. Urabe Y, Mann DL, Kent RL et al (1992) Cellular and ventricular contractile dysfunction in experimental canine mitral regurgitation. Circ Res 70:131–147

    Article  CAS  PubMed  Google Scholar 

  14. He S, Fontaine AA, Schwammenthal E, Yoganathan AP, Levine RA (1997) Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies. Circulation 96:1826–1834

    Article  CAS  PubMed  Google Scholar 

  15. Otsuji Y, Handschumacher MD, Schwammenthal E et al (1997) Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 96:1999–2008

    Article  CAS  PubMed  Google Scholar 

  16. Enriquez-Sarano M, Tajik AJ, Bailey KR, Seward JB (1993) Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation: influence of eccentricity of jet and mechanism of regurgitation. J Am Coll Cardiol 21:1211–1219

    Article  CAS  PubMed  Google Scholar 

  17. Glick BN, Roberts WC (1992) Usefulness of total 12-lead QRS voltage in diagnosing left ventricular hypertrophy in clinically isolated, pure, chronic, severe mitral regurgitation. Am J Cardiol 70:1088–1092

    Article  CAS  PubMed  Google Scholar 

  18. Lancellotti P et al (2013) Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 14:611–644

    Article  PubMed  Google Scholar 

  19. Tribouilloy C, Shen WF, Quéré JP, Rey JL, Choquet D, Dufossé H et al (1992) Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging. Circulation 85:1248–1253

    Article  CAS  PubMed  Google Scholar 

  20. Enriquez-Sarano M, Miller FA Jr, Hayes SN, Bailey KR, Tajik AJ, Seward JB (1995) Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 25:703–709

    Article  CAS  PubMed  Google Scholar 

  21. Enriquez-Sarano M, Dujardin KS, Tribouilloy CM, Seward JB, Yoganathan AP, Bailey KR et al (1999) Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation. Am J Cardiol 83:535–541

    Article  CAS  PubMed  Google Scholar 

  22. Mauri L et al (2013) 4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am Coll Cardiol 62(4):317–328. doi:10.1016/j.jacc.2013.04.030

    Article  PubMed  Google Scholar 

  23. Suri RM, Schaff HV, Dearani JA et al (2006) Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg 82:819

    Article  PubMed  Google Scholar 

  24. Enriquez-Sarano M, Akins CW, Vahanian A (2009) Mitral regurgitation. Lancet 373:1382–1394

    Article  PubMed  Google Scholar 

  25. Seneviratne B, Moore GA, West PD (1994) Effect of captopril on functional mitral regurgitation in dilated heart failure: a randomised double blind placebo controlled trial. Br Heart J 72:63

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Van Bommel RJ et al (2011) Cardiac resynchronization therapy as a therapeutic option in patients with moderate-severe functional mitral regurgitation and high operative risk. Circulation 124:912

    Article  PubMed  Google Scholar 

  27. Brandt RR, Reiner C, Arnold R et al (2006) Contractile response and mitral regurgitation after temporary interruption of long-term cardiac resynchronization therapy. Eur Heart J 27:187

    Article  PubMed  Google Scholar 

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Correspondence to Marco Flori .

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Flori, M., Scappini, L., Piangerelli, L. (2015). Mitral Regurgitation. In: Capucci, A. (eds) Clinical Cases in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-19926-9_16

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  • DOI: https://doi.org/10.1007/978-3-319-19926-9_16

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19925-2

  • Online ISBN: 978-3-319-19926-9

  • eBook Packages: MedicineMedicine (R0)

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