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.
Subject(s)
Angioplasty, Balloon, Coronary , Echocardiography, Doppler , Mitral Valve Insufficiency/diagnostic imaging , Acute Disease , Aged , Analysis of Variance , Chi-Square Distribution , Coronary Angiography , Coronary Disease/complications , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Echocardiography, Doppler/instrumentation , Echocardiography, Doppler/methods , Echocardiography, Doppler/statistics & numerical data , Electrocardiography , Female , Humans , Incidence , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/epidemiology , Mitral Valve Insufficiency/etiologyABSTRACT
In a patient with obstructive left atrial myxoma, we analyzed by pulsed Doppler echocardiography the flow pattern through the mitral valve and in the pulmonary veins. Two mitral flow patterns were observed: the first was present near the medial commissure and along the anterior leaflet and was characterized by the absence of mid-to-late diastolic filling flow; the second was found near the lateral commissure and was characterized by the obstruction of mid-to-late diastolic filling flow, mimicking mitral stenosis. The pulmonary vein flow showed brief and rapidly decelerating anterograde diastolic flow wave and an early systolic retrograde flow wave. These waves were respectively related to the diastolic forward and the systolic backward movement of the tumor. This case report shows that pulmonary vein flow analysis may give new insights into left atrial filling and emptying dynamics in left atrial myxoma.
