Atriogenic Mitral Valve Reflux: Diastolic Mitral Incompetence Following Isolated Atrial Systoles

Abstract

Cardiac and aortic pressures were recorded after stellate gangliooectomy and vagotomy. Acute heart block was produced by injecting the atrioventricular node, and atrial and ventricular systoles were controlled electronically to occur independently or in any desired relationship. Angiocardiograms recorded on video tape after injections of 4 ml 69% Renovist into the left ventricle were analyzed with a videodensitometer able to detect small refluxes of contrast medium into the left atrium and correlate them with phases of the cardiac cycle. When ventricular driving was temporarily suspended but atrial driving continued, pressure records indicated mitral valve closure after each atrial systole, but reflux of contrast medium into the atrium occurred after each systole not followed by a normally sequenced ventricular systole. Driving with a 2 : 1 atrioventricular stimulation resulted in reflux, with the alternate atrial contraction dissociated from ventricular systole. Thus, the mitral valve was not effectively closed by atrial systoles that were not followed by normally sequenced ventricular systoles.

Diastolic mitral regurgitation. Haemodynamic and angiographic correlation.

“…For all this, diastolic mitral regurgitation remains a curiosity. Late diastolic mitral regurgitation has been described together with reversal of the left atrioventricular pressure gradient in experimental and clinical studies (Williams et al, 1968;Rutishauser et al, 1966;Lochaya, Igarashi, and Shaffer, 1967). In these reports the mitral valve was established or judged to be normal, and, therefore, incomplete closure of the valve was a causal factor of mitral regurgitation.…”

Diastolic mitral regurgitation following transcatheter aortic valve replacement: Incidence, predictors, and association with clinical outcomes

“…Previous studies and pathophysiological considerations DMR, described initially decades ago but never studied quantitatively, results from an interplay between two mandatory conditions: diastolic atrioventricular pressure gradient reversal and incomplete closure of the mitral valve. Effective mitral valve closure requires intactness of the valve apparatus and is dependent on properly-synchronized, normal LV contraction [1,17,18]. Therefore, DMR can occur with AVB of any degree (in which dyssynchronous atrioventricular contraction occurs); acute aortic regurgitation [19][20][21][22] or cardiomyopathies [3,23] (in which the rapid rise in LV pressure exceeding left atrial pressure precedes ventricular systole); and/or lesions of the mitral valve apparatus [24,25].…”

Drug-Related Valvular Heart Disease: Here We Go Again: Will We Do Better This Time?

“…The terms trace, minimal, mild, and physiological valve regurgitation (VR) must also be interpreted appropriately. The sophisticated, elegant studies by Williams et al [4][5][6][7][8] from Earl Wood's laboratory at the Mayo Clinic in Roches-ter, Minn, were sensitive for detecting mitral regurgitation (MR) and provided important information. These investigators placed sampling catheters just above and below the mitral valve, and "slight retrograde flow of indicator" was uniformly found in dogs with normal sinus rhythm.…”