A Case of Ruptured Mitral Valve Aneurysm Complicating Long-Standing Aortic Regurgitation

A 53-year-old man with aortic regurgitation was admitted to our hospital because of fever. A diagnosis of ruptured mitral valve aneurysm was made by Doppler echocardiography. Aortic regurgitant flow along the anterior mitral leaflet may have predisposed to mitral valve endocarditis, aneurysm formation, and its rupture.     

Severe Mitral and Aortic Regurgitation in Association with Ankylosing Spondylitis

Aortic disease and aortic valve regurgitation are well documented in association with ankylosing spondylitis, although involvement of the mitral valve occurs more rarely. We report a case of severe mitral and aortic regurgitation in association with ankylosing spondylitis. We then discuss the characteristic cardiac manifestations that may occur in association with ankylosing spondylitis and the associated echocardiographic features.     

High Occurrence of Mitral Valve Prolapse in Cardiac Catheterization Patients with Pure Isolated Mitral Regurgitation

ABSTRACT. Danielsen R, Nordrehaug JE, Vik-Mo H (Department of Clinical Physiology, Haukeland Hospital, University of Bergen, Bergen, Norway). High occurrence of mitral valve prolapse in cardiac catheterization patients with pure isolated mitral regurgitation. Acta Med Scand 1987; 221:33–8. The aetiological spectrum of angiographically verified pure isolated mitral regurgitation (MR) was studied in 48 consecutive adult patients (35 males). Severe MR was found in 35 patients (73%) and moderate MR in 13 patients (27%). Mitral valve prolapse (MVP) syndrome was found in 21 patients (44%). These were younger than the rest of the study population (55±13 vs. 62±6 years, p<0.05) and 15 (71%) of them were men. Endocarditis and chordal rupture occurred in 19% and 43% of the MVP patients. Sixteen patients (33%) had MR secondary to myocardial infarction while only three patients (6%) had MR of rheumatic aetiology. Bacterial endocarditis, hypertensive heart disease, hypertrophic obstructive car-diomyopathy and mitral annulus calcification were less frequently found. Mitral valve replacement was done in 20 (57%) of the patients with severe MR and MVP was the underlying disease in 15 (75%) of these patients. In conclusion, MVP is a frequent cause of pure isolated MR and of mitral valve replacement. In contrast to the preponderance of young females amongst MVP patients in population surveys, most of the MVP patients with MR in this study are middle-aged and elderly men.     

Impact of TAVI on Mitral Regurgitation: A Prospective Echocardiographic Study

Objective: This study aims to assess changes in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI). Background: Existing data on MR after TAVI are contradictory. Methods: Thirty‐five patients with MR graded ≥ 2+ were followed after undergoing TAVI with either the Edwards Sapien or CoreValve device. Echocardiography was performed the week before and 3 months after the procedure. MR was graded on a scale of 0 to 4+, classified as organic or functional, and the effective regurgitant orifice area (EROA) and MR index were calculated. Results: At baseline, MR was graded 4+ in 4 (11.4%) patients, 3+  in 10 (28.6%), and 2+ in 21 (60%). At follow‐up, MR was graded at 3+ in 4 (11.4%) patients, 2+ in 8 (22.9%), and 1+ in 19 (54.3%); 4 (11.4%) exhibited no MR. EROA (24.4 ± 11.5 mm² pre‐TAVI vs. 11.2 ± 10.3 mm² post‐TAVI, P < 0.001) and MR index (1.9 ± 0.3 pre‐TAVI vs. 1.3 ± 0.7 post‐TAVI, P < 0.001) were reduced with TAVI, independent of the etiology. MR decreased by at least 1 grade in 28 (80%) patients, with a reduction ≥2 grades in 10 (28.6%) patients; no patient showed a worsened condition. Subgroup analyses showed that the reduction in MR was significant in patients treated with the Edwards Sapien device but not in patients treated with the CoreValve device. Conclusions: This multiparametric echocardiographic evaluation showed that MR improved significantly after TAVI and that this result may be related to the type of valve implanted.     

缺血性二尖瓣关闭不全的外科治疗

目的：本文旨在回顾性研究单中心外科治疗缺血性二尖瓣关闭不全的临床经验。方法：回顾性分析279例缺血性二尖瓣关闭不全患者的临床资料。平均年龄59.2±7.4岁。心功能分级II级141例,III级117例,IV级21例。左室舒末内径57~91mm ,左室射血分数20%~59%。二尖瓣反流程度：中度156例,中-重度75例,重度48例。冠脉造影结果三支病变240例,两支病变30例,单支病变9例。结果：二尖瓣成形术224例,术后即刻TEE示无返流152例,微量返流43例,微量-轻度21例,轻度8例。二尖瓣置换术75例,IABP辅助37例。冠状动脉旁路移植远端吻合口3.6±0.5个。手术死亡13例,死亡率4.7%（13/279）。出院时左室舒末内径46~86mm,左室射血分数20%~62% 。二尖瓣无反流232例,微量26例,轻度12例,轻-中度7例,中度2例。 结论：外科治疗冠心病合并缺血性二尖瓣关闭不全可获得满意的治疗效果,尤其是对于射血分数降低、左心增大、心力衰竭的患者,获益更大。