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[Prominent mitral L wave in a patient with partial pericardiectomy: a possible new etiology]

Mustafa Aparcı1, Omer Yiğiner, Ejder Kardeşoğlu

  • 1GATA Haydarpaşa Eğitim Hastanesi Kardiyoloji Kliniği, İstanbul, Turkey. maparci@gmail.com

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir
|January 6, 2011
PubMed

Insights

A prominent mitral L wave, seen in diastolic dysfunction, disappeared during supraventricular tachycardia. This finding in a post-pericardiectomy patient highlights the complex interplay of cardiac rhythms and diastolic function.

Area of Science:

  • Cardiology
  • Cardiac Physiology
  • Echocardiography

Background:

  • Middiastolic flow (mitral L wave) can indicate impaired diastolic function.
  • A 48-year-old female with prior partial pericardiectomy presented with cardiac abnormalities.

Observation:

  • Echocardiography revealed left ventricular hypertrophy, mitral regurgitation, and mitral annular calcification.
  • Pulse-Doppler showed a prominent forward transmitral flow (mitral L wave).
  • Supraventricular tachycardia episodes coincided with the disappearance of the mitral L wave, while E and A waves persisted.

Findings:

  • The mitral L wave's presence and absence correlated with specific cardiac rhythms.
  • Respiratory variations in transmitral flow were minimal (<25%) during deep inspiration.
  • Tissue Doppler imaging demonstrated equal E' and A' wave velocities (0.06 m/sec) at the lateral mitral annulus.

Implications:

  • The study suggests supraventricular tachycardia can transiently abolish the mitral L wave, impacting diastolic function assessment.
  • Understanding these dynamic changes is crucial for diagnosing and managing diastolic dysfunction in complex cardiac conditions.
  • This case underscores the importance of simultaneous electrocardiographic and echocardiographic monitoring in evaluating intricate cardiac phenomena.

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