Document Detail


Eclipsed mitral regurgitation: a new form of functional mitral regurgitation for an unusual cause of heart failure with normal ejection fraction.
MedLine Citation:
PMID:  17934266     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transient functional mitral regurgitation (MR) has never been reported as a cause of heart failure (HF) with normal ejection fraction (EF) in the absence of epicardial coronary artery stenosis. RESULTS: Performance of echocardiography in patients with acute HF before initiation of HF medical treatment allowed identification of three patients with normal EF but transient massive functional MR during the HF episode. In all patients, massive MR occurred as a consequence of sudden extreme apical tenting of both leaflets with total lack of coaptation, despite normal EF and absence of detectable left ventricular (LV) remodeling, and despite absence of significant stenosis on coronary arteries. In all patients MR was triggered by methylergonovine injection and was reversible either spontaneously or after nitroglycerine administration, leaving patients with normal echocardiogram between HF episodes. In two patients, long-term administration of calcium channel blockers prevented recurrences of MR and HF, whereas in one, mitral valve was eventually replaced. CONCLUSION: Sudden reversible apical tenting of mitral leaflets with subsequent torrential MR and acute HF can occur despite normal EF, absence of pre-existing LV remodeling and absence of coronary artery stenosis. This atypical type of functional MR is an unusual mechanism of HF in patients with normal LVEF.
Authors:
Jean-François Avierinos; Franck Thuny; Laurence Tafanelli; Sebastien Renard; Virginie Chalvignac; Eric Guedj; Marc Lambert; Jacques Quilici; Jean-Louis Bonnet; Maurice Enriquez-Sarano; Gilbert Habib
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Publication Detail:
Type:  Journal Article     Date:  2007-10-10
Journal Detail:
Title:  Cardiology     Volume:  110     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2008  
Date Detail:
Created Date:  2008-04-02     Completed Date:  2008-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  29-34     Citation Subset:  IM    
Affiliation:
Cardiology Department, Timone Hospital, Marseille, France. jfavierinos@ap-hm.fr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Combined Modality Therapy
Coronary Angiography
Echocardiography, Doppler
Electrocardiography
Female
Heart Failure / etiology*,  physiopathology,  therapy
Humans
Male
Mitral Valve Insufficiency / complications*,  diagnosis*,  drug therapy
Prognosis
Radionuclide Imaging / methods
Reference Values
Risk Assessment
Sampling Studies
Severity of Illness Index
Stroke Volume / physiology*
Thallium
Thallium Radioisotopes / diagnostic use
Ventricular Remodeling / physiology
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes; 7440-28-0/Thallium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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