scholarly journals An unusual triphasic transmitral flow: A special case of “mid-diastolic mitral regurgitation” due to acute aortic regurgitation

2021 ◽  
Author(s):  
Susumu Odajima ◽  
Kensuke Matsumoto ◽  
Eriko Hisamatsu ◽  
Kenji Okada ◽  
Ken-ichi Hirata
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Aortic Regurgitation ◽  
Decompensated Heart Failure ◽  
Transmitral Flow ◽  
Short Summary ◽  
Special Case

Short summary A 51-year-old man presented with decompensated heart failure due to acute aortic regurgitation; he also showed “mid-diastolic mitral regurgitation”, presumably originating from pressure crossover between the left ventricle and atrium.

The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

2020 ◽  
Vol 75 (5) ◽  
pp. 514-522
Author(s):  
Alexey S. Ryazanov ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Effective Area ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Angiotensin Receptor ◽  
Optimal Drug ◽  
Patients With Heart Failure ◽  
Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

scholarly journals Anterior mitral valve aneurysm perforation in a patient with preexisting aortic regurgitation

2015 ◽  
Vol 78 (4) ◽  
Author(s):  
Rodolfo Citro ◽  
Angelo Silverio ◽  
Roberto Ascoli ◽  
Antonio Longobardi ◽  
Eduardo Bossone ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Connective Tissue ◽  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Connective Tissue Disorders ◽  
Threatening Condition ◽  
Life Threatening

We report the case of a 71-year-old man hospitalized for acute heart failure. Transthoracic and transesophageal echocardiography showed mitral valve aneurysm (MVA) rupture and severe mitral regurgitation. No vegetations but significant aortic regurgitation were also observed. MVA perforation is a rare life-threatening condition that typically occurs as a complication of endocarditis but may also be associated with other diseases, in particular connective tissue disorders. In the present case, the absence of such etiology suggests a possible role for of aortic regurgitation in MVA rupture secondary to a “jet lesion” mechanism.

scholarly journals P305 The evaluation of left ventricle filling pressure and lung ultrasound B-lines in the diagnosis of cardiogenic dyspnea

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Valova
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Filling Pressure ◽  
Diagnostic Methods ◽  
Grey Zone ◽  
X Ray ◽  
B Lines

Abstract Introduction Dyspnea is the most frequent symptom of acute heart failure but it could also be a clinical presentation of some other noncardiogenic conditions. The differentiation of the origin of dyspnea could sometimes be a difficult task. The estimated elevation of left ventricle filling pressure with lung ultrasound proved positive B-lines score > 15 could be reliable as diagnostic methods for acute decompensated heart failure and proof of the cardiogenic origin of dyspnea. Purpose To evaluate the reliability of elevated left ventricle filling pressure and positive lung ultrasound B-lines score in differentiation of the origin of dyspnea. Methods Elevated E/e´>15 as a proof for elevated left ventricle filling pressure and multiple bilateral LUS B-lines (>15) were tested against conventional X-ray and NT-proBNP in 44 patients with cardiogenic dyspnea (23 NYHA III patients and 21 NYHA IV patients) and 42 patients with noncardiogenic dyspnea. Results Elevated left ventricle filling pressure detected with echocardography (E/e´>15) as a proof of acute decompensated heart failure was found in 18 NYHA IV patients and strongly correlated with multiple bilateral LUS B-lines > 15 (all 21 NYHA IV patients), alveolar edema from conventional X-ray (21 NYHA IV patients) and NTproBNP > 1000pg/ml in 17 NYHA IV patients. The results for NYHA III patients differ very much. Elevated filling pressure (E/e´ > 15) from echocardiography was found in 10 patients NYHA III. For the left 13 patients NYHA III E/e´ was in grey zone between 8-14. Multiple bilateral LUS B-lines >15 were found in 18 NYHA III patients. Interstitial pulmonary edema was found in 15 NYHA III patients and NTproBNP > 1000pg/ml was found in 16 NYHA III patients. E/e´ between 8-14 (grey zone) moderately correlated with NT-proBNP and strongly with pulmonary blood flow redistribution and interstitial edema from X-ray. Normal left ventricle filling pressure (E/e´ < 8) was found in 36 noncardiogenic patients. Only 6 patients with noncardiogenic dyspnea were with elevated left ventricle filling pressure (E/e´ > 15) which was explained with their overweight (BMI > 30) and hypervolemia and correlated with negative LUS B-lines. Only 1 patient with noncardiogenic dyspnea was with false positive B-lines score > 15 typical for pneumonia. Conclusions Elevated left ventricle filling pressure detected with Tissue Doppler echocardiography (E/e´>15) and positive LUS B-lines score > 15 are reliable modalities for the diagnosis of cardiogenic dyspnea in patients NYHA IV. In patient NYHA III with cardiogenic dyspnea the two presented modalities proved to be with moderate reliability and need references from conventional X-ray and NT-proBNP.

scholarly journals Surgical treatment of secondary mitral regurgitation in heart failure: a present-day view

2021 ◽  
Vol 13 (1) ◽  
pp. 40-48
Author(s):  
E. G. Agafonov ◽  
M. A. Popov ◽  
D. I. Zybin ◽  
D. V. Shumakov
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Volume Overload ◽  
Left Ventricular ◽  
Functional Class ◽  
Functional Mitral Regurgitation ◽  
Admission Rates ◽  
Replacement Surgery

Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on the waiting list for heart transplantation.Purpose. The purpose of this article is to review the role of surgical management in patients with heart failure complicated by mitral regurgitation.Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.

scholarly journals Laporan Kasus: Anestesi Blok Peribulbar pada Pasien dengan Gagal Jantung Kongestif yang Dilakukan Enukleasi

2019 ◽  
Vol 7 (2) ◽  
pp. 134-138
Author(s):  
Muhamad Adli ◽  
Caroline Wullur
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Mitral Regurgitation ◽  
Aortic Regurgitation ◽  
Hypertensive Heart Disease ◽  
Functional Class ◽  
Cardiac Depression ◽  
Peribulbar Block ◽  
Class Iv

Seorang pria berusia 73 tahun datang ke Instalasi Gawat Darurat Pusat Mata Nasional Rumah Sakit Mata Cicendo pada bulan November 2018 dengan keluhan nyeri mata yang mengeluarkan darah dan disertai dengan keluhan sesak. Pemeriksaan mata menunjukkan prolaps okuli dan direncanakan untuk dilakukan enukleasi. Ahli kardiologi mendiagnosis sebagai hypertensive heart disease, congestive heart failure functional class IV, moderate mitral regurgitation, moderate aortic regurgitation. Laporan kasus ini bertujuan memaparkan keberhasilan tata laksana anestesi pada pasien usia lanjut dengan gagal jantung kongestif yang dilakukan enukleasi dalam blok peribulbar. Teknik blok peribulbar dipilih agar tidak memperberat masalah kardiovaskular serta untuk meminimalisir depresi kardiak. Teknik ini dilakukan dengan menyuntikkan obat anestesi lokal levobupivakain 0,5% pada inferotemporal, medial kantus, dan superonasal. Operasi berlangsung tanpa keluhan nyeri dan fluktuasi hemodinamik yang signifikan. Pascaoperasi pasien sadar penuh dengan skala nyeri NRS 60 menit pascaoperasi 0. Hal ini menunjukkan bahwa teknik anestesi blok peribulbar memberikan hasil memuaskan pada tindakan enukleasi. Enucleation under Peribulbar Block Anesthesia in Patients with Congestive Heart Failure: A Case ReportA 73-year-old male patient was presented to the emergency department of the National Eye Center Cicendo Hospital with a painful and bloody eye as well as shortness of breath. Eye examination revealed ocular prolapse and patient was scheduled for enucleation. The cardiologist diagnosed the patient with hypertensive heart disease, congestive heart failure functional class IV, moderate mitral regurgitation, and moderate aortic regurgitation. Patient then underwent treatment for six days. This case report aimed to describe the successful management of anesthesia in elderly patients with congestive heart failure who underwent peribulbar block for enucleation procedure. To prevent further cardiac problems and to minimize the risk of cardiac depression in this patient, the anesthetic technique chosen was peribulbar block with the injection of local anesthetic drug levobupivacaine 0.5% at the inferotemporal, medial canthus, and superonasal. The surgary took place without complaints of intraoperative pain and without significant hemodynamic fluctuations. Postoperatively, the patient was fully conscious and sixty minutes postoperative pain scale (Numeric Rating Scale) in this patient was 0. This shows that the peribulbar block anesthesia technique can provide satisfactory results for enucleation procedure.

How should I treat a patient with severe mitral regurgitation and acute decompensated heart failure?

2015 ◽  
Vol 10 (9) ◽  
pp. e1-e6
Author(s):  
Michael Donahue ◽  
Maria Teresa Librera ◽  
Gabriella Visconti ◽  
Amelia Focaccio ◽  
Bruno Golia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Severe Mitral Regurgitation
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