Summary
Incompetence of the mitral valve may occur within days or weeks following myocardial infarction. The ethiology most often encountered is rupture of a papillary muscle or one or more chordae tendineae. Since echocardiography is available, dysfunction of the papillary muscle with resulting incompetence of the valve is diagnosed more frequently. The mortality of the disease without surgical correction is reported as high as 95% within the first 3 months following the development of a murmur. The results of the surgical therapy are closely related to the time interval between myocardial infarction and time of surgery. Twenty-one (46%) of 45 patients with acute mitral regurgitation following myocardial infarction and cardiogenic shock operated upon at the Pacific Medical Center died during the early postoperative period. Mortality was extremely high with 78% when surgery had to be done within the first weeks following the acute myocardial infarction. Surgery within 2 to 3 months following the myocardial infarction carried a mortality of 44%, whereas only 6 of 22 patients operated upon more than 3 months after the acute infarction died. The high mortality of the natural course of the disease should be encouragement to think of the possibility of surgical correction of the valvular disease, especially when optimal medical treatment including medical and mechanical inotropic support have failed. Advances in cardial surgery, such as myocardial protection as well as postoperative care, may result in further improvement of the results
Zusammenfassung
Eine Insuffizienz der Mitralklappe kann Tage oder Wochen nach einem akuten Herzinfarkt auftreten. Häufigste Ursachen sind Papillarmuskelruptur und Abrisse einzelner oder mehrerer Sehnenfäden. Eine Dysfunktion der Papillarmuskel mit daraus resultierender Insuffizienz des Klappenapparates wird mit Verbreitung der Echocardiographie zunehmend häufiger diagnostiziert. Die Letalität des chirurgisch unbehandelten Leidens wird mit bis zu 95% innerhalb der ersten drei Monate nach dem akuten Ereignis angegeben. Die Ergebnisse der chirurgischen Therapie korrelieren eng mit dem Zeitintervall zwischen akutem Infarkt und operativer Korrektur. Von 45 wegen akuter Mitralklappeninsuffizienz nach Herzinfarkt und cardiogenem Schock am Pacific Medical Center operierten Patienten verstarben 21 (46%). Die Mortalität war mit 78% am höchsten in der Gruppe derer, die innerhalb eines Monats nach dem akuten Infarkt operiert werden mußten. Die Mortalität betrug 44% während des zweiten und dritten Monats, während jeder fünfte derer verstarb, die mehr als drei Monate nach dem Infarkt operiert wurden. Die hohe Letalität bei natürlichem Verlauf des Leidens sollte Anlaß dazu sein, bei Versagen der medizinischen Therapie nicht nur an die Möglichkeit der mechanischen Kreislaufunterstützung, sondern auch an die Bereitstellung cardio-chirurgischer Möglichkeiten zu denken. Verbesserte Operationsmethoden und optimale Myocardprotektion während des Eingriffs, sowie verbesserte postoperative Betreuung dürften die Ergebnisse der chirurgischen Therapie weiter verbessern.
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Krebber, H.J., Gerbode, F. Mitralinsuffizienz nach Herzinfarkt. Klin Wochenschr 57, 1259–1264 (1979). https://doi.org/10.1007/BF01492981
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DOI: https://doi.org/10.1007/BF01492981