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Triphasic mitral inflow documented by Doppler echocardiography and cardiac catheterization: a case study

Ikuo Misumi1, Kenji Ebihara, Ryuichiro Akahoshi

  • 1Department of Cardiology, Kumamoto Saishunsou Hospital, Japan. misumi@saisyunsou1.hosp.go.jp

Internal Medicine (Tokyo, Japan)
|March 23, 2011
PubMed

Insights

This case study highlights triphasic mitral inflow patterns in patients with diastolic dysfunction, revealing unique left ventricular pressure dynamics during impaired diastolic filling.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Physiology

Background:

  • An 85-year-old woman with hypertension presented with chest pain.
  • Echocardiography revealed left ventricular (LV) hypertrophy, reduced systolic function (ejection fraction 40%), and mitral regurgitation.

Observation:

  • Pulsed Doppler revealed triphasic mitral inflow velocity.
  • Simultaneous LV and pulmonary artery wedge (PAW) pressures showed elevated mean PAW pressure with a prominent v wave.
  • LV pressure exhibited early diastolic elevation, a mid-diastolic decrease, and late diastolic elevation exceeding PAW pressure.

Findings:

  • The mid-diastolic decrease in LV pressure, despite filling, was attributed to abrupt inflow volume increase from impaired diastolic function.
  • This pressure behavior deviates from conventional pressure-volume relations in diastolic dysfunction.

Implications:

  • Triphasic mitral inflow is a characteristic indicator of diastolic dysfunction.
  • Understanding these unique LV pressure dynamics is crucial for diagnosing and managing diastolic heart failure.

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