‘Continuously regurgitating mitral valve’: systolic and diastolic mitral regurgitation in a case of severe aortic regurgitation and complete heart block

Rajesh, Gopalan Nair; Raju, Deepak; Krishnan, M.N.

doi:10.1136/heartasia-2013-010388

Cited by 4 publications

(2 citation statements)

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“…A delayed LV contraction mostly coincides with a certain kind of arrhythmia, such as AVB or rapid atrial arrhythmia with long intermission. 8 When these arrhythmias conform to certain conditions, DMR will be induced based on the two aforementioned essential factors. It is worth mentioning that the ‘overdue’ LV systole is the most common mechanism of DMR.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series

Liu

Zuo

et al. 2020

European Heart Journal - Case Reports

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Background Diastolic mitral regurgitation (DMR) is a type of functional mitral regurgitation. Its occurrence in the diastolic phase of cardiac cycle renders DMR an easily ignored entity. Confusing it with systolic mitral regurgitation occasionally happens. The reversal of left atrioventricular pressure gradient during diastole and the incomplete closure of mitral valve are the essential conditions for DMR. Diastolic mitral regurgitation develops under various situations, where the mechanisms of diastolic reversal of left atrioventricular pressure gradient differ. Case summary Patient 1 was a 50-year-old man diagnosed with 2:1 second-degree atrioventricular block (AVB). Patient 2 was a 70-year-old man diagnosed with first-degree AVB. Patient 3 was a 66-year-old man diagnosed with atrial fibrillation with long intermission and occasional atrial flutter with unequal conduction. Patient 4 was a 54-year-old woman diagnosed with dilated cardiomyopathy with complete left bundle branch block. Patient 5 was a 36-year-old man diagnosed with severe acute aortic regurgitation secondary to subacute bacterial endocarditis. Discussion Although the degree of DMR is relatively mild, its appearance generally prompts further clinical considerations. The appreciation of DMR has an incremental value for diagnosing and evaluating the underlying cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series

Liu

Zuo

et al. 2020

European Heart Journal - Case Reports

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“…Diastolic regurgitation of mitral or tricuspid valve had a low velocity of 1-2 m/s. [1]. Because the complete AV block did not improved to sinus rhythm, a permanent pacemaker implantation was performed.…”

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confidence: 99%

Diastolic Tricuspid and Mitral Regurgitation in a Patient with Complete Atrio-Ventricular Block

Yoon¹

2017

J Clin Case Rep

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Complete atrioventricular (AV) block is a well-known cause of diastolic AV regurgitation. In patients with complete AV block, the effective and synchronized ventricular systole may not occur at the end of diastole, leading to the incomplete closure of AV valve. And the reversal pressure gradient between ventricle and atrium due to the delay in ventricular systole results in diastolic AV regurgitation. We report a case of tricuspid and mitral regurgitation after new-onset complete AV block. Keywords: Complete atrioventricular block; Diastolic atrioventricular regurgitation Case ReportA 78-years old women with a history of aortic valve replacement surgery presented with approximately one week of dyspnea on exertion and dizziness. Previously, his electrocardiogram showed sinus rhythm with left bundle branch block ( Figure 1) and mild degree of tricuspid regurgitation was detected by thoracic echocardiogram, but there was no diastolic AV regurgitation ( Figure 2). On physical examination, her blood pressure was 166/82, her pulse was slow and regular, and there was a systolic murmur on cardiac apex. Chest X ray on admission revealed cardiomegaly without pulmonary congestion. The electrocardiography showed complete AV block with a heart rate of 38/ min (Figure 3). The patient was evaluated by thoracic echocardiography. Thoracic echocardiography showed normally left ventricular ejection fraction with mild left atrial dilatation. Mild to moderate degree of mitral regurgitation and tricuspid regurgitation were demonstrated with diastolic regurgitation. Color flow imaging and continuous-wave Doppler clearly showed diastolic mitral and tricuspid regurgitation (Figure 4). Diastolic regurgitation of mitral or tricuspid valve had a low velocity of 1-2 m/s. [1]. Because the complete AV block did not improved to sinus rhythm, a permanent pacemaker implantation was performed. After then, the diastolic mitral and tricuspid regurgitation disappeared. DiscussionDiastolic mitral regurgitation has been reported in patients with atrioventricular conduction abnormalities [2]. And tricuspid regurgitation is usually accompanied with diastolic mitral regurgitation. Diastolic mitral regurgitation can also occur in patients with acute severe aortic regurgitation or restrictive cardiomyopathies [3].Normally the mitral and tricuspid valve closes shortly after the isovolumetric ventricular contraction when the rising ventricular pressure exceeds the atrial pressure. For the complete closure of AV valve, the effective and synchronized ventricular contraction is essential. Incomplete closure of the AV valve is related to valvular regurgitation [1,3-

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Acute presentations of infective endocarditis

Jolobe¹

2019

The American Journal of Emergency Medicine

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‘Continuously regurgitating mitral valve’: systolic and diastolic mitral regurgitation in a case of severe aortic regurgitation and complete heart block

Cited by 4 publications

References 1 publication

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series

Diastolic Tricuspid and Mitral Regurgitation in a Patient with Complete Atrio-Ventricular Block

Acute presentations of infective endocarditis

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