Acute Ischemic Mitral Regurgitation Treated by Percutaneous Coronary Intervention after an Accurate Diagnosis on Transesophageal Echocardiography
An 80-year-old woman with acute posterolateralmyocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic echocardiography (TTE) showed dysfunction of the left ventricular inferolateral wall motion and severe mitral valve regurgitation (MR). Emergenc...
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| Published in | Internal Medicine Vol. 60; no. 9; pp. 1417 - 1421 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Japan
The Japanese Society of Internal Medicine
01.05.2021
Japan Science and Technology Agency |
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| Abstract | An 80-year-old woman with acute posterolateralmyocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic echocardiography (TTE) showed dysfunction of the left ventricular inferolateral wall motion and severe mitral valve regurgitation (MR). Emergency coronary angiography revealed triple-vessel stenosis. We performed transesophageal echocardiography in the catheter room to diagnose the cause of MR. Severe tenting of the mitral valve and no rupture of the papillary muscles were revealed. We considered ischemic MR likely to improve with revascularization and performed percutaneous coronary intervention. Subsequently, the patient's circulatory dynamics rapidly stabilized, and MR was significantly improved on follow-up TTE. |
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| AbstractList | An 80-year-old woman with acute posterolateralmyocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic echocardiography (TTE) showed dysfunction of the left ventricular inferolateral wall motion and severe mitral valve regurgitation (MR). Emergency coronary angiography revealed triple-vessel stenosis. We performed transesophageal echocardiography in the catheter room to diagnose the cause of MR. Severe tenting of the mitral valve and no rupture of the papillary muscles were revealed. We considered ischemic MR likely to improve with revascularization and performed percutaneous coronary intervention. Subsequently, the patient's circulatory dynamics rapidly stabilized, and MR was significantly improved on follow-up TTE. An 80-year-old woman with acute posterolateral myocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic echocardiography (TTE) showed dysfunction of the left ventricular inferolateral wall motion and severe mitral valve regurgitation (MR). Emergency coronary angiography revealed triple-vessel stenosis. We performed transesophageal echocardiography in the catheter room to diagnose the cause of MR. Severe tenting of the mitral valve and no rupture of the papillary muscles were revealed. We considered ischemic MR likely to improve with revascularization and performed percutaneous coronary intervention. Subsequently, the patient's circulatory dynamics rapidly stabilized, and MR was significantly improved on follow-up TTE. |
| Author | Nozato, Toshihiro Nagamine, Sho Watanabe, Keita Nakamura, Tomofumi Ashikaga, Takashi Miyazaki, Ryoichi Kaneko, Masakazu Nagata, Yasutoshi Hara, Nobuhiro |
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| Keywords | between papillary muscles diameter ischemic mitral valve regurgitation tethering transesophageal echocardiography tenting height acute myocardial infarction |
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| Notes | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 Correspondence to Dr. Ryoichi Miyazaki, rmiyazaki44@gmail.com |
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| References | 9. Kumanohoso T, Otsuji Y, Yoshifuku S, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 125: 135-143, 2003. 11. Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. N Engl J Med 377: 2419-2432, 2017. 5. Tanimoto T, Imanishi T, Kitabata H, et al. Prevalence and clinical significance of papillary muscle infarction detected by late gadolinium-enhanced magnetic resonance imaging in patients with ST-segment elevation myocardial infarction. Circulation 122: 2281-2287, 2010. 1. Chevalier P, Burri H, Fahrat F, et al. Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation. Eur J Cardiothorac Surg 26: 330-335, 2004. 3. Le Feuvre C, Metzger JP, Lachurie ML, Georges JL, Baubion N, Vacheron A. Treatment of severe mitral regurgitation caused by ischemic papillary muscle dysfunction: indications for coronary angioplasty. Am Heart J 123: 860-865, 1992. 6. Czarnecki A, Thakrar A, Fang T, et al. Acute severe mitral regurgitation: consideration of papillary muscle architecture. Cardiovasc Ultrasound 6: 5, 2008. 4. Nishino S, Watanabe N, Kimura T, et al. The course of ischemic mitral regurgitation in acute myocardial infarction after primary percutaneous coronary intervention: from emergency room to long-term follow-up. Circ Cardiovasc Imaging 9: e004841, 2016. 7. Moursi MH, Bhatnagar SK, Vilacosta I, San Roman JA, Espinal MA, Nanda NC. Transesophageal echocardiographic assessment of papillary muscle rupture. Circulation 94: 1003-1009, 1996. 8. Otsuji Y, Handschumacher MD, Schwammenthal E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 96: 1999-2008, 1997. 2. Stout KK, Verrier ED. Acute valvular regurgitation. Circulation 119: 3232-3241, 2009. 10. Nishino S, Watanabe N, Kimura T, Kuriyama N, Shibata Y. Acute versus chronic ischemic mitral regurgitation. Circ Cardiovasc Imaging 11: e007028, 2018. 11 1 2 3 4 5 MH Moursi (7) 1996; 94 6 8 9 10 |
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| Snippet | An 80-year-old woman with acute posterolateralmyocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic... An 80-year-old woman with acute posterolateral myocardial infarction, cardiogenic shock, and acute heart failure was admitted to our hospital. Transthoracic... |
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| SubjectTerms | acute myocardial infarction Angiography Angioplasty between papillary muscles diameter Case Report Catheters Congestive heart failure Echocardiography Infarction Internal medicine Ischemia ischemic mitral valve regurgitation Mitral valve Muscles Regurgitation Stenosis Stents tenting height tethering transesophageal echocardiography Ventricle |
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| Title | Acute Ischemic Mitral Regurgitation Treated by Percutaneous Coronary Intervention after an Accurate Diagnosis on Transesophageal Echocardiography |
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