Natural history of the flail mitral leaflet syndrome: A serial 2-dimensional echocardiographic study

DePace, Nicholas L.; Mintz, Gary S.; Ren, Jian‐Fang; Kotler, Morris N.; Mattleman, Steven; Victor, Mark F.; Ross, John; Mintz, Paul S.

doi:10.1016/0002-9149(83)90416-2

Cited by 17 publications

(3 citation statements)

References 15 publications

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“…43,44 That variation may be explained by poorly defined severity of mitral regurgitation, various selection biases and small study populations. [43][44][45][46][47][48] A series from Ling et al examined 229 patients with mitral regurgitation due to flail leaflet, many of who were symptomatic, had atrial fibrillation or evidence of left ventricular dysfunction. 49 Patients who were treated medically had a mortality rate significantly higher than the expected (6.3% yearly mortality, p = 0.016, when compared with the expected rate in the US population according to the 1990 census).…”

Section: Natural History Progression and Predictors Of Outcomes In Mmentioning

confidence: 99%

Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of ‘‘watchful waiting’’ versus ‘‘early surgical intervention’’ for severe, asymptomatic, primary mitral regurgitation are addressed.

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Section: Natural History Progression and Predictors Of Outcomes In Mmentioning

confidence: 99%

Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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“…It is important to differentiate chronic severe mitral regurgitation from acute severe mitral regurgitation; immediate mitral valve replacement or reconstruction is indicated in the acute situation. Patients with chronic circumstances may survive for years without valve surgery [16].…”

Section: Acute Myocardial Infarctionmentioning

confidence: 99%

Imaging of ischemic heart disease

et al. 2002

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Despite advances in the understanding and treatment of ischemic cardiomyopathy, characterized by extensive coronary artery disease and left ventricular (LV) dysfunction, the prognosis remains poor with only a 50-60% 5-year survival rate. The composition of atherosclerotic lesions is currently regarded as being more important than the degree of stenosis in determining acute events. If imaging techniques could distinguish vulnerable from stable plaques, then high-risk patient subgroups could be identified. Another important concept is that LV dysfunction may be the result of either scarring due to necrosis or to the presence of myocardial hibernation, in which there is sufficient blood flow to sustain viable myocytes, but insufficient to maintain systolic contraction. This concept of myocardial viability is critical for making optimal clinical management decisions. This review describes how noninvasive imaging methods can be used to distinguish regions of irreversibly injured myocardium from viable but hibernating segments. Technical advances in CT and MR have made imaging of the beating heart possible. Considerable clinical progress has already been made and further cardiac applications are expected. Radiologists therefore have new opportunities for involvement in cardiac imaging but must recognize the political implications as well as the diagnostic potential of these modalities not only for the heart, but also for the whole vascular system. This review focuses on imaging myocardial injury. It compares state-of-the-art CT and MR with more established yet contemporary echocardiography and nuclear scintigraphy.

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“…Also, signs of rheumatic or redundant mitral valve pathologic conditions may be detected. In addition to assessing left ventricular size and func- tion, areas of segmental wall motion abnormality suggesting an acute ischemic process can also be detected with two-dimensional imaging [19]. Vegetations from endocarditis are readily visualized, especially if they are larger than 2 mm in diameter.…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Acute Mitral Regurgitation

Crawford

1986

J Intensive Care Med

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Address reprint requests to Dr Crawford.The mitral apparatus is a complex structure with many components. Diseases affecting any part of this apparatus may result in acute mitral regurgitation. The most common causes are ruptured chordae tendineae and ischemic dysfunction of the papillary muscles. Sudden disruption of the mitral apparatus markedly elevates pulmonary capillary pressure and results in acute pulmonary edema. Consequently, patients with acute mitral regurgitation usually are admitted to acute care facilities. The physical examination sometimes is misleading because the characteristic holosystolic murmur may be absent. In some patients with acute mitral regurgitation, such high left atrial pressures develop during the latter part of systole that the pressure gradient between the left ventricle and atrium is obliterated, resulting in cessation of the murmur in late systole. This regurgitant v wave in the left atrial or pulmonary capillary pressure tracing is the characteristic hemodynamic finding in acute mitral regurgitation, but it may not always be present. Currently, the best diagnostic technique is two-dimensional and Doppler echocardiography. The former provides anatomic detail of the mitral apparatus, and the latter confirms and quantifies the mitral regurgitation. Although left ventricular angiography can be used to make the diagnosis, Doppler echocardiographs provide more information, are equally sensitive, and are noninvasive. Cardiac catheterization is now largely used to define the coronary anatomy prior to valvar operation. Management of patients with acute mitral regurgitation includes the use of vasodilators, mechanical circulatory support, and finally valvoplasty or replacement.The mitral valve apparatus is a complex structure made up of the mitral anulus, valve leaflets, chordae tendineae, papillary muscles, and the supporting left ventricular wall. Acute disruption of the function of any of these components of the apparatus can lead to immediate mitral regurgitation. Acute disruption of the mitral apparatus with resulting mitral regurgitation is almost always accompanied by prominent clinical symptoms. Accordingly, patients with acute mitral regurgitation often are seen first at acute care centers and usually are

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Natural history of the flail mitral leaflet syndrome: A serial 2-dimensional echocardiographic study

Cited by 17 publications

References 15 publications

Primary mitral valve regurgitation: Update and review

Primary mitral valve regurgitation: Update and review

Imaging of ischemic heart disease

Acute Mitral Regurgitation

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