RESUMO
Background Aortic regurgitation (AR) usually occurs in diastole in presence of an incompetent aortic valve. Systolic AR is a rare phenomenon occurring in patients with reduced left ventricular systolic pressure and atrial fibrillation or premature ventricular contractions. Its occurrence is a Doppler peculiarity and adds to the hemodynamic burden. Aim Rheumatic carditis is often characterised by acute or subacute severe mitral regurgitation (MR) due to flail anterior mitral leaflet and elongated chords. In patients with acute or subacute MR, developed left ventricular systolic pressure may fall in mid and late systole due to reduced afterload and end-systolic volume and may be lower than the aortic systolic pressure, causing flow reversal in aorta and systolic AR. Material and methods 17 patients with acute rheumatic fever were studied in the echocardiography lab during the period 2005–2015. Five patients had severe MR of which two had no AR and hence were excluded from the study. Three young male patients (age 8–24 years) who met modified Jones’ criteria for rheumatic fever with mitral and aortic valve involvement were studied for the presence of systolic AR. Results In presence of acute or subacute severe MR, flail anterior mitral valve and heart failure, all three showed both diastolic and late systolic AR by continuous-wave and color Doppler echocardiography. Conclusion Systolic AR is a unique hemodynamic phenomenon in patients with acute rheumatic carditis involving both mitral and aortic valves and occurs in presence of severe MR.
RESUMO
BACKGROUND: Flail mitral valve due to ruptured chordae tendinae usually result in actue, severe mitral regurgitation. Because transesophageal echocardiography with color Doppler flow mapping permits high resolution imaging of mitral valve anatomy and mitral regurgitation, we compared this procedure with transthoracic echocardiography in the diagnosis and evaluation of flail mitral valve. METHODS: From 1990 to 1992 years, fourteen patients (7 males, 7 females ; age range 30-81years)with flail mitral valve admitted to Kyung Hee University was evaluated by transesophageal echocardiography and transthoracic echocardiography. RESULTS: 1) Transthoracic echocardiography revealed 11 cases of abnormal coaptation, I case of ruptured chordae tendinae and 2 cases not defined. Compared with transthoracic imaging, transesophageal echocardiography revealed 13 cases of abnormal coaptation and I case of ruptured chordae tendinae. 2) The site of flail leaflet was 6 cases in anterior, 7 cases in posterior and one case was not defined with transthoracic echocardiography. With transesophageal echocardiography, the site was 5 cases in anterior, 5 cases in posterior and 4 cases in both leaflets. 3) By color flow mapping, MR jet directed toward anterior in 5, posterior in 7 and both in 2 with transthoracic echocardiography. With transesophageal echocardiography,MR jet directed toward anterior in 5, posterior in 7 and both in 4. 4) In a flail anterior leaflet, transesophageal echocardiography showed abnormal leaflet coaptation in systole, displacement of the unsupported anterior leaflet into the left atrium and formation of a regurgitant channel between the mitral leaflets. By Doppler color flow pattern, mitral regurgitation associated with a flail anterior leaflet moved in a counter-clockwise direction around the left atrium in the standard 4 chamber view, whereas regurgitation associated with a flail posterior leaflet moved in a clockwise direction. Regurgitation associated with flail anterior and posterior leaflets moved in both directions. CONCLUSION: Transesophageal echocardiography with color Doppler flow mapping of mitral regurgitation were complementary to transthoracic echocardiography in the diagnosis and localization of flail mitral valve.