Alterations in transmitral flow dynamics in patients with early mitral valve closure and aortic regurgitation

Eusébio, José; Louie, Eric K.; Edwards, Lonnie C.; Loeb, Henry S.; Scanlon, Patrick J.

doi:10.1016/0002-8703(94)90593-2

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…Marked elevation of left ventricular diastolic pressure can cause early closure of the mitral valve, and tachycardia will limit mitral inflow, resulting in decreased ventricular filling. 14 The presence of preexisting chronic aortic regurgitation and ventricular enlargement may blunt the hemodynamic impact of acutely worsened regurgitation. Conversely, preexisting disease processes that impair diastolic function, such as hypertension or aortic stenosis, may result in markedly more dramatic clinical presentation of acute aortic regurgitation.…”

Section: Aortic Valve Regurgitationmentioning

confidence: 99%

Acute Valvular Regurgitation

2009

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Section: Aortic Valve Regurgitationmentioning

confidence: 99%

Acute Valvular Regurgitation

2009

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“…The study of acute aortic regurgitation has been very limited by small sample sizes (<10 patients) due to the relative rarity of the underlying pathology 5–7,9 . Our sample of 90 patients represents the largest sample to date.…”

Section: Discussionmentioning

confidence: 99%

“…This prevents transmission of the high LVEDP to the left atrium. If LVEDP increases further, this mechanism is overcome and the mitral valve opens in late diastole leading to diastolic mitral regurgitation 6–8 . This reduces LVEDP but increases left atrial pressure.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and echocardiographic predictors of decompensation in acute severe aortic regurgitation due to infective endocarditis

et al. 2021

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Background: Patients with acute severe aortic regurgitation (AR) due to infective endocarditis can progress rapidly from the hemodynamically stable patient to pulmonary edema and cardiogenic shock. We sought to identify patients at risk of decompensation where emergent surgery should be undertaken. Methods:We identified 90 patients with acute severe AR from the echocardiography laboratory database. Baseline clinical, hemodynamic (heart rate (HR) and blood pressure (BP)), and echocardiographic data including mitral filling, premature mitral valve closure (PMVC), and diastolic mitral regurgitation (DMR) were identified. The primary endpoint was subsequent development of pulmonary edema or severe hemodynamic instability.Results: Patients who met the primary endpoint had a higher HR (98.5 bpm vs 80.5 bpm), lower diastolic BP (54 mm Hg vs 61.5 mm Hg), higher mitral E-wave velocity (113 cm/s vs 83 cm/s), higher E/e′ ratio (12.4 vs 8), higher proportion of DMR (27.8% vs 7.4%), and PMVC (25% vs 9.3%) than patients who did not meet the endpoint. The proportion of patients with the primary endpoint increased as HR increased ((≤81 bpm) 3/30 (10%), (81-94 bpm) 11/31 (35.5%), (≥94 bpm) 22/29 (75.9%), P < .0001) and as the diastolic BP reduced ((≤54 mm Hg) 19/31 (61.3%), (54-63 mm Hg) 12/31 (38.7%), (≥63 mm Hg) 5/28 (17.9%), P = .003). Independent predictors were a higher HR (OR 1.08 (95% CI 1.04-1.13) P = .0003) and DMR (OR 4.71 (95% CI 1.23-18.09), P = .02). Conclusion:Decompensation in acute severe AR is common. Independent predictors of decompensation are increasing HR(≥94 bpm) and the presence of DMR. Those with these adverse markers should be considered for emergent surgery.

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“…The first is caused by the aortic regurgitation, which increases left ventricular filling pressure and prematurely interrupts the transmitral flow. 5,6 The second is explained by a reversal of the gradient through the mitral valve occurring in late diastole. 7 Both premature closure of the mitral valve and late diastolic regurgitation may be observed also in other pathophysiologic conditions like atrioventricular conduction delay, severe systolic dysfunction with mechanical dyssynchrony and increased left ventricular pressure due to restrictive filling.…”

Section: Discussionmentioning

confidence: 99%

Doppler Markers of Elevated Left Atrial and Ventricular Filling Pressure in a Critically Ill Patient

et al. 2013

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Accurate assessment of intracardiac flows by Doppler echocardiography may add important hemodynamic information in the critically ill patient. Detailed analysis of flow gradients through different sites and their correlation with timing of cardiac events may help us in better understanding the pathophysiology of the underlying disease. We report the clinical case of a 78-year-old patient with septic shock, in whom an A-dip of aortic regurgitation, shortening of diastolic filling, and diastolic mitral regurgitation were detected by Doppler analysis. Pathophysiologic explanation of these phenomena and their evolution after inotropic drug infusion are reported.

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Alterations in transmitral flow dynamics in patients with early mitral valve closure and aortic regurgitation

Cited by 9 publications

References 17 publications

Acute Valvular Regurgitation

Acute Valvular Regurgitation

Clinical and echocardiographic predictors of decompensation in acute severe aortic regurgitation due to infective endocarditis

Doppler Markers of Elevated Left Atrial and Ventricular Filling Pressure in a Critically Ill Patient

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