A reappraisal of papillary muscle dysfunction

Shelburne, James C.; Rubinstein, Dorothy; Gorlin, Richard

doi:10.1016/0002-9343(69)90087-4

Cited by 71 publications

(5 citation statements)

References 20 publications

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“…'4, 17, 20 This might be better understood if one considers the blood supply of the papillary muscles. The anterior papillary muscle receives its blood supply from branches of the left anterior descending and circumflex arteries, while the posterior muscle gets its blood supply from branches of the right coronary and left circumflex arteries in 70%, from the right coronary artery alone in 20%, and the left circumflex artery in 10% of the cases.34 36 The presence of severe obstructive coronary artery disease in all of our cases appears to be the most important contributing factor accounting for the differences in the number of prolapsed scallops observed, since normal mitral valve function depends on a rather complex and finely coordinated system of which the papillary muscle is one of the principal components.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve prolapse and coronary artery disease. Clinical, hemodynamic, and angiographic correlations.

Aranda¹,

Befeler²,

Lazzara³

et al. 1975

Circulation

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Section: Discussionmentioning

confidence: 99%

Mitral valve prolapse and coronary artery disease. Clinical, hemodynamic, and angiographic correlations.

Aranda¹,

Befeler²,

Lazzara³

et al. 1975

Circulation

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“…function of the mitral apparatus with resulting mitral regurgitation [4-131. The syndrome of papillary muscle dysfunction as the etiology has been characterized in selected patient groups [9,14,15,16]. The purpose of this study is to characterize the clinical, electrocardiographic, and angiographic findings in a large number of patients with coronary heart disease and mitral regurgitation to define further the clinical significance of mitral regurgitation in this setting.…”

Section: Competency Of the Mitral Valve Depends Upon The Functional Imentioning

confidence: 99%

“…Like us, he found that generalized hypokinesis and ventricular aneurysm were significantly more frequent in the group with mitral incompetence, whereas the frequency of localized contraction abnormalities was not significantly different in the two groups. Mitral insufficiency associated with congestive heart failure is invariably associated with an abnormal left ventricular contractile pattern ranging from localized contractile abnormality to generalized hypokinesis [4,8,9,11,15,16,21].…”

mentioning

confidence: 99%

The clinical and hemodynamic significance of mitral regurgitation in coronary artery disease

Zeldis

Hamby

Aintablian

1980

Cathet. Cardiovasc. Diagn.

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To evaluate the significance of mitral regurgitation in coronary artery disease (CAD), clinical, electrocardiographic, and angiographic data in 100 coronary artery disease patients with mitral regurgitation were compared to data in 100 coronary artery disease patients without mitral regurgitation. Mitral regurgitation was mild (1+) to moderate (2+) in 94 patients. Heart failure, cardiomegaly, and anterior myocardial infarction were more common in mitral regurgitation patients than in controls (33 vs 4;47 vs 8;22 vs 5, respectively, P < 0.001). The frequency of inferior myocardial infarction was equal in both groups. Significant left anterior descending and circumflex disease was equally frequent; however, right coronary disease was more frequent in patients with mitral regurgitation (87 vs 68, P < 0.001). Total vessel occlusions and triple-vessel disease were more frequent in patients with mitral regurgitation (113 vs 78, P < 0.01; 60 vs 40, P < 0.001, respectively). No localized area of asynergy was more common in patients or controls,, but left ventricular aneurysms and generalized hypokinesis were more common in patients with mitral regurgitation (6 vs 0; 23 vs 2; P < 0.001). These data suggest that mitral regurgitation is most often mild, but is associated with significant left ventricular dysfunction and advanced CAD.

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“…On the basis of anatomical and radiological studies it has been suggested that their contribution is twofold; firstly, tension exerted through the chordae tendineae at end-diastole draws the valve cusps toward a position of partial closure; secondly, early contraction of these muscles compensates for ventricular shortening during systole and thus prevents bulging of the valve leaflets into the atrium and associated mitral regurgitation (Shelburne, Rubinstein, and Gorlin, 1969;Tsakiris et al, 1970). Infarction and asynergy of a portion of the left ventricle at the base of a papillary muscle may interfere with proper functioning of this structure by means of a change in directional axis (Shelburne et al, 1969). Paradoxical expansion of an inferior wall aneurysm may carry the base of the papillary muscle away from its normal position, thus changing the normal spatial three-dimensional alignment necessary for proper mitral valve closure.…”

Section: Left Ventriclementioning

confidence: 99%

Mitral valve prolapse in patients with coronary artery disease. Echocardiographic-angiographic correlation.

Raizada¹,

Benchimol²,

Desser³

et al. 1977

Heart

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Echocardiography was performed in 25 consecutive patients with angina pectoris and angiographically demonstrable coronary artery disease. Left ventricular echograms detected late or pansystolic mitral valve bowing suggesting of mitral valve proplapse in 6/25 (24%). Left ventricular angiography showed prolapse of the posterior mitral leaflet in 15/25 (60%), including 5 detected by echocardiography. Significant triple vessel coronary disease was present in 11 of 15 patients with prolapsed mitralvalve. In each of the latter a greater than 90 per cent obstructive lesion was noted in at least one coronary artery: right coronary artery, 9 subjects (82%); left circumflex coronary artery, 5 patients (33%); and left anterior descending coronary artery, 4 patients (27%). Of 15 subjects with angiographic evidence of mitral valve prolapse, 13 had left ventricular asynergy-inferior or inferoposterior in 8 subjects (62%) and anterior or anteroapical in 5 subjects (38%). Eleven subjects had vectorcardiographic evidence of transmural myocardial infarction-inferior or inferoposterior in 9 (82%) and anteroseptal in 2 (18%). A single subject with mitral valve prolapse had mild mitral regurgitation. It is concluded that: (1) coexisting prolapse of the posterior mitral valve leaflet and coronary artery disease is usually associated with triple vessel obstructive lesions, (2) severe right coronary disease, inferior left ventricular wall asynergy, and inferior myocardial infarction are important angiographic and vectorcardiographic correlates, and (3) echocardiography will detect such mitral valve prolapse in only one-third of affected cases.

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A reappraisal of papillary muscle dysfunction

Cited by 71 publications

References 20 publications

Mitral valve prolapse and coronary artery disease. Clinical, hemodynamic, and angiographic correlations.

Mitral valve prolapse and coronary artery disease. Clinical, hemodynamic, and angiographic correlations.

The clinical and hemodynamic significance of mitral regurgitation in coronary artery disease

Mitral valve prolapse in patients with coronary artery disease. Echocardiographic-angiographic correlation.

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