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Color Doppler study of mitral regurgitation during percutaneous transluminal coronary angioplasty
L M Biasucci1, A Lombardo, E Rossi
1Institute of Cardiology, Catholic University Sacro Cuore, Rome, Italy.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) can cause mitral regurgitation (MR), especially during circumflex artery occlusion. This functional MR is linked to specific wall motion abnormalities, not valve issues.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Mitral regurgitation (MR) is a potential complication during percutaneous transluminal coronary angioplasty (PTCA).
- Understanding the mechanisms of MR during PTCA is crucial for patient management.
Purpose of the Study:
- To evaluate the occurrence and characteristics of MR during PTCA in patients with one-vessel coronary artery disease.
- To investigate the relationship between coronary artery occlusion, left ventricular function, and MR.
Main Methods:
- Color Doppler echocardiography was used to assess MR in 28 patients undergoing PTCA.
- Left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were monitored during brief coronary artery occlusion.
Main Results:
- Significant decreases in LVEF and WMSI were observed during artery occlusion.
- PTCA-related MR (>2+) occurred in two patients, both during circumflex artery occlusion.
- Lateral akinesia/dyskinesia was specifically associated with circumflex artery occlusion and MR.
Conclusions:
- Brief occlusion of the proximal circumflex artery during PTCA can frequently induce functional MR.
- This MR is related to specific lateral wall motion abnormalities and not to mitral valve prolapse or annular dilation.
Abstract:
Mitral regurgitation (MR) was evaluated by color Doppler echocardiography during percutaneous transluminal coronary angioplasty (PTCA) in 28 patients with one-vessel artery disease (left anterior descending artery in 11, right coronary artery in 8, and circumflex artery in 9) and normal left ventricular function. In all three groups, left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) decreased significantly during artery occlusion in comparison with baseline values (no differences among various groups). Anterior and inferior akinesia/dyskinesia was observed in all patients during left anterior descending and right coronary artery occlusion, respectively. Lateral akinesia/dyskinesia was induced by occlusion of the circumflex artery in six patients (all with proximal lesions [p < 0.05 vs the other two groups]) and the right coronary artery in one. Only the six patients with circumflex artery occlusion showed PTCA-related MR (> 2+ in two). LVEF and WMSI were similar during artery occlusion in patients with and without MR. Neither mitral leaflet prolapse nor anulus dilation occurred during PTCA in any of the patients. Our data show that during brief occlusion of the proximal circumflex artery, functional MR (usually mild) frequently occurs in relation to specific lateral akinesia/dyskinesia.