Combined Papillary Muscle and Left Ventricular Wall Dysfunction as a Cause of Mitral Regurgitation

Mittal, Ajay Kumar; Langston, Manly F.; Cohn, Keith; Selzer, Arthur; Kerth, William J.

doi:10.1161/01.cir.44.2.174

Cited by 130 publications

(38 citation statements)

References 13 publications

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“…Experimental damage to the PMs themselves, however, fails to produce MR acutely without damage to the underlying myocardial wall as well. 16 Burch et al 14,15 alternatively postulated restricted leaflet motion. The PMs, normally parallel to the LV long axis and perpendicular to the leaflets, efficiently balance forces generated by ventricular pressure on the leaflet surface.…”

Section: Mechanismsmentioning

confidence: 99%

“…First, although PM damage does not produce MR acutely, MR does occur in the chronic phase of ethanol injection, with PM scarring and retraction. 16 Second, occasional patients with MI actually do have prolapse with PM elongation. 38 These observations, rather than disproving tethering, actually confirm that tethering distance is the final common pathway determining the level of leaflet coaptation.…”

Section: Mechanismsmentioning

confidence: 99%

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Ischemic Mitral Regurgitation on the Threshold of a Solution

2005

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Section: Mechanismsmentioning

confidence: 99%

Section: Mechanismsmentioning

confidence: 99%

Ischemic Mitral Regurgitation on the Threshold of a Solution

2005

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“…6). However, multiple experimental studies have reported that isolated PM dysfunction did not cause ischemic MR. [36][37][38][39][40] In addition, clinical studies have also reported that leaflet prolapse in patients with ischemic MR is very rare. 6)7)20) Therefore, the relationship between PM dysfunction and ischemic MR is not yet clear.…”

Section: P Pm M D Dy Ys Sf Fu Un Nc Ct Ti Io On Nmentioning

confidence: 99%

Mechanism of Ischemic Mitral Regurgitation

Levine

Takeuchi

Sakata

2008

J Cardiovasc Ultrasound

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I In ns si ig gh ht ts s F Fr ro om m MMi it tr ra al l L Le ea af fl le et t C Co on nf fi ig gu ur ra at ti io on ns s: : I Im mp po or rt ta an nc ce e o of f L Le ea af fl le et t T Te et th he er ri in ng g Apical displacement of the leaflets relative to the annulus is an important characteristic of the configuration of the mitral leaflets. Apical displacement of the leaflets and the coaptation relative to the annulus in patients with ischemic MR was initially observed by Ogawa et al. and by Godley, Weyman, and colleagues (Fig. 1). 6)7) In principle, the spatial position of the systolic leaflets and the coaptation can be determined by 2 superimposed and opposing forces acting on the leaflets. Increased LV pressure acts to push the leaflets toward the left atrium, while tethering force of the chordae pulls the leaflets to prevent leaflet prolapse into the left atrium. Therefore, , , M Ma as sa aa ak ki i T Ta ak ke eu uc ch hi i, , M

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“…Investigative work done by Underwood et al (1970) and Mittall et al (1971) in dogs has shown that experimentally induced ischemia in papillary muscles does not commonly lead to mitral regurgitation unless there is involvement of the adjoining free ventricular wall. The degree of ischemic compromise of the remaining left ventricle is an additional major factor in determining the magnitude of the regurgitation.…”

Section: Clinical Presentationmentioning

confidence: 99%

Ruptured papillary muscle, a complication of myocardial infarction: Clinical presentation, diagnosis, and treatment

Clements

Story

Hurst

et al. 1985

Clinical Cardiology

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Summary: Ruptured papillary muscle due to myocardial infarction was encountered in 14 patients during the period [1975][1976][1977][1978][1979][1980][1981][1982][1983]. Five of the 14 patients had a history of angina pectoris and two had a history of prior myocardial infarction. Eleven patients with myocardial infarction developed additional pain due to myocardial ischemia and/or a murmur of mitral regurgitation and pulmonary edema within a week, 3 others had a prolonged course with intermittent pain due to myocardial ischemia and breathlessness for longer periods and then deteriorated. Thirteen of our 14 patients developed a murmur and all but one had pulmonary edema on the chest x-ray. Five patients had infarction patterns on the electrocardiogram, the remainder of the patients had only ST-and T-wave changes.Echocardiograms showed fine flutter and notching of the anterior mitral leaflets and vigorous contractions of the left ventricle. Only one patient was demonstrated to have a papillary muscle tip prolapsing into the left atrium on two-dimensional echocardiography . Twelve patients underwent surgery and 8 survived. Seven patients had singlevessel coronary disease, 4 involving the circumflex system and 3 involving the right coronary system. Four of the 7 patients with single-vessel coronary disease survived surgery. Five patients went to surgery with the intra-aortic balloon pump in place and only 3 survived. Three others had the pump inserted intraoperatively and 2 of these survived. Six of 9 patients who had mitral valve replacement and coronary bypass survived. Ejection fraction ranged from 40 to 79 % . Surgical survival did seem to be related to the extent of papillary muscle rupture, with the best results occurring in the group with a small portion of the tip ruptured. Seven patients had a stormy clinical course and required surgery within 10 days of rupture. Four of these 7 survived. It seems reasonable to believe that these patients who often have small infarction and limited coronary disease have good potential for survival. Our approach has been to move toward surgery once the diagnosis is made to avoid the sudden deterioration that frequently occurs. The surgical mortality in this group remains in the 30 to 40% range.

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Combined Papillary Muscle and Left Ventricular Wall Dysfunction as a Cause of Mitral Regurgitation

Cited by 130 publications

References 13 publications

Ischemic Mitral Regurgitation on the Threshold of a Solution

Ischemic Mitral Regurgitation on the Threshold of a Solution

Mechanism of Ischemic Mitral Regurgitation

Ruptured papillary muscle, a complication of myocardial infarction: Clinical presentation, diagnosis, and treatment

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