Related Experiment Video
Updated: Jul 24, 2025
An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
Acute mitral regurgitation with and without acute heart failure
Konstantinos Dean Boudoulas1, Filippos Triposkiadis2, Sara Koenig3
1Division of Cardiovascular Medicine, The Ohio State University, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA.
Abstract:
Acute severe mitral regurgitation (MR) is rare, but often leads to cardiogenic shock, pulmonary edema, or both. Most common causes of acute severe MR are chordae tendineae (CT) rupture, papillary muscle (PM) rupture, and infective endocarditis (IE). Mild to moderate MR is often seen in patients with acute myocardial infarction (AMI). CT rupture in patients with floppy mitral valve/mitral valve prolapse is the most common etiology of acute severe MR today. In IE, native or prosthetic valve damage can occur (leaflet perforation, ring detachment, other), as well as CT or PM rupture. Since the introduction of percutaneous revascularization in AMI, the incidence of PM rupture has substantially declined. In acute severe MR, the hemodynamic effects of the large regurgitant volume into the left atrium (LA) during left ventricular (LV) systole, and in turn back into the LV during diastole, are profound as the LV and LA have not had time to adapt to this additional volume. A rapid, but comprehensive evaluation of the patient with acute severe MR is essential in order to define the underline cause and apply appropriate management. Echocardiography with Doppler provides vital information related to the underlying pathology. Coronary arteriography should be performed in patients with an AMI to define coronary anatomy and need for revascularization. In acute severe MR, medical therapy should be used to stabilize the patient before intervention (surgery, transcatheter); mechanical support is often required. Diagnostic and therapeutic steps should be individualized, and a multi-disciplinary team approach should be utilized.
Insights
Acute severe mitral regurgitation (MR) requires rapid evaluation to identify causes like chordae tendineae rupture. Prompt diagnosis and a multidisciplinary approach are crucial for effective management of this rare but serious condition.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Critical Care Medicine
Background:
- Acute severe mitral regurgitation (MR) is a rare condition with potentially fatal consequences, including cardiogenic shock and pulmonary edema.
- Common etiologies include chordae tendineae (CT) rupture, papillary muscle (PM) rupture, and infective endocarditis (IE).
- CT rupture in patients with mitral valve prolapse is the leading cause of acute severe MR.
Purpose of the Study:
- To emphasize the critical need for rapid and comprehensive evaluation in patients presenting with acute severe MR.
- To outline the essential diagnostic modalities and therapeutic strategies for managing acute severe MR.
- To highlight the importance of a multidisciplinary team approach in optimizing patient outcomes.
Main Methods:
- Echocardiography with Doppler is vital for assessing underlying pathology and hemodynamic impact.
- Coronary arteriography is indicated in patients with acute myocardial infarction (AMI) to guide revascularization strategies.
- Medical therapy is employed for initial stabilization, often supplemented by mechanical circulatory support.
Main Results:
- The hemodynamic consequences of acute severe MR are profound due to the rapid volume overload of the left atrium and left ventricle.
- Prompt diagnosis and intervention can mitigate the risks of cardiogenic shock and pulmonary edema.
- Percutaneous revascularization has reduced the incidence of PM rupture in AMI patients.
Conclusions:
- A swift and thorough diagnostic workup is essential for identifying the cause of acute severe MR.
- Individualized treatment plans, combining medical stabilization with timely intervention (surgical or transcatheter), are crucial.
- A collaborative, multidisciplinary team approach is paramount for effective management and improved prognosis in acute severe MR.
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
01:23Mitral Regurgitation II: Clinical Features and Diagnostic Tests
01:28Mitral Regurgitation IV: Nursing Management
01:25Mitral Regurgitation III: Medical Management
01:22Mitral Stenosis I: Introduction
01:15Aortic Regurgitation I: Introduction