Skip to main content

Advertisement

SpringerLink
Log in

Acute mitral regurgitation with and without acute heart failure

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

Not applicable.

References

  1. Boudoulas H, Wooley CF (1991) Mitral regurgitation-chronic versus acute: implications for timing of surgery. In Contemporary Internal Medicine. Clinical Case Studies, Volume 3. Bowen JM, Mazzaferri AL (eds). Plenum Publishing Corporation, pp 1–35

  2. Harb SC, Griffin BP (2017) Mitral valve disease: a comprehensive review. Curr Cardiol Rep, Valvular Hear Dis

  3. Boudoulas H, Wooley CF (eds) (2000) Mitral Valve: floppy mitral valve, mitral valve prolapse, mitral valvular regurgitation. Second revised edition; Futura Publishing Company Inc

  4. Thomson CR, Buller CE, Sleeper LA et al (2000) Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction; a report from the SHOCK Trial Registry: should we emergently revascularize Occluded Coronaries in cardiogenic shock? J Am Coll Cardiol 36(suppl A):1104–1109

    Article  Google Scholar 

  5. Stout KK, Verrier ED (2009) Acute valvular regurgitation. Circulation 119:3232–3241

    Article  PubMed  Google Scholar 

  6. Xanthopoulos A, Butler J, Parissis J, Polyzopoulou E, Skoularigis J, Triposkiadis F (2020) Acutely decompensated versus acute heart failure: two different entities. Heart Fail Rev 25:907–916

    Article  PubMed  Google Scholar 

  7. Boudoulas KD, Borer JS, Boudoulas H (2013) Etiology of valvular heart disease in the 21st century. Cardiology 126:139–152

    Article  PubMed  Google Scholar 

  8. Gabbay U, Yosely C (2010) The underlying causes of chordae tendineae rupture: a systematic review. Intern J Cardiol 143:113–118

    Article  Google Scholar 

  9. Nishino S, Watanabe N, Kimura T et al (2016) The course of ischemic mitral regurgitation in acute myocardial infarction after primary percutaneous coronary intervention. Circ Cardiovasc Imaging

  10. Bursi F, Enriquez-Sarano M, Nkomo VT et al (2005) Heart failure and death after myocardial infarction in the community. The emerging role of mitral regurgitation. Circulation 111:295–301

    Article  PubMed  Google Scholar 

  11. Sannino A, Greyburn PA (2016) Ischemic mitral regurgitation after acute myocardial infarction in the percutaneous coronary intervention era. Circ Cardiovasc Imaging 9:e005323

    Article  PubMed  Google Scholar 

  12. Angelini A, Ho SY, Thiene G, Anderson RH (2000) Anatomy of the mitral valve. In Mitral Valve. Boudoulas H, Wooley CF (eds) Second revised edition; Futura Publishing Company Inc. pp 5–29

  13. Davies MJ, Moore PB, Brainridge MV (1978) The floppy mitral valve; incidence, pathology, and complications in surgical, necropsy, and forensic material. Br Heart J 40:468–481

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Boudoulas KD, Pitsis A, Mazzaferri EL, Gunina RJ, Triposkiadis F, Boudoulas H (2020) Floppy mitral valve/mitral valve prolapse: a complex entity with multiple genotypes and phenotypes. Progr Cardiovasc Dis 63:308–326

    Article  Google Scholar 

  15. Boudoulas KD, Pitsis A, Boudoulas H (2016) Floppy mitral valve (FMV)- mitral valve prolapse (MVP)-mitral valvular regurgitation and the FMV/MVP syndrome. Hellenic J Cardiol 57:73–85

    Article  PubMed  Google Scholar 

  16. Olson LJ, Subramanian R, Ackermann DM, Orszulak TA, Edwards WD (1987) Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc 62:22–34

    Article  CAS  PubMed  Google Scholar 

  17. Gridioni F, Enriquez-Sarano M, Ling LH et al (1999) Sudden death in mitral regurgitation due to flail leaflet. J Am Coll Cardiol 34:2078–2085

    Article  Google Scholar 

  18. Maron MS, Olivotto I, Harrigan C et al (2011) Mitral valve abnormalities identified by cardiovascular magnetic resonance represent a primary phenotypic expression of hypertrophic cardiomyopathy. Circulation 124:4047

    Article  Google Scholar 

  19. Boissier F, Achkouty G, Bruneval R et al (2015) Rupture of mitral valve chordae in hypertrophic cardiomyopathy. Arch Cardiov Dis 108:244–249

    Article  Google Scholar 

  20. Chin FH, Yang CJ, Huag CK et al (2018) Spontaneous chordae tendineae rupture during pregnancy. Am J Emerg Med 36:1127.e1–1127e3

    Google Scholar 

  21. Shiraishi I, Nishimura K, Sakaguchi H et al (2014) Acute chordae tendineae rupture of the mitral valve in infants: a nationwide survey in Japan exploring a new syndrome. Circulation 130:1053–1061

    Article  PubMed  Google Scholar 

  22. Torigoe T, Sakaguchi H, Kitamo M et al (2012) Clinical characteristics of acute mitral regurgitation due to rupture chordae tendineae in infancy-experience of a single institution. Eur J Pediatr 171:259–265

    Article  PubMed  Google Scholar 

  23. Simmons TA, Meijburg AW, de Riviere AB (2001) Traumatic papillary muscle rupture. Ann Thor Surg 72:257–259

    Article  Google Scholar 

  24. Watanabe N (2019) Acute mitral regurgitation. Heart 105:671–677

    Article  PubMed  Google Scholar 

  25. Lanz J, Wyss D, Rober L et al (2019) Mechanical complications in patients with ST segment elevation myocardial infarction: a single center experience. PLoS ONE 14:e0209502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Damluzi A, van Diepen S, Katz JN et al (2021) Mechanical complications of acute myocardial infarction. A scientific statement of the American Heart Association. Circulation 144(issue 2):e16–235

    Google Scholar 

  27. Baddour LM, Wilson WR, Bayer AS et al (2015) Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 132:1435–1486

    Article  CAS  PubMed  Google Scholar 

  28. Roman JA, Vilacosta I, Lopez J, Sarria C (2015) Critical questions about left-sided infective endocarditis. J Am Coll Cardiol 66:1068–1076

    Article  Google Scholar 

  29. Murdoch DR, Corey GR, Hoen B et al (2009) Clinical presentation, etiology and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis prospective cohort study. Arch Int Med 169:463–473

    Article  Google Scholar 

  30. Simard T, Vemulapalli S, Jung RG et al (2022) Transcatheter edge-t-edge mitral valve repair in patients with severe mitral regurgitation and cardiogenic shock. J Am Coll Cardiol 80:2072–2084

    Article  PubMed  Google Scholar 

  31. Tang GHL, Estevez-Loureiro R, Yu Y et al (2021) Survival following edge-to-edge transcatheter mitral valve repair in patients with cardiogenic shock: a nationwide analysis. J Am Heart Assoc 10:e019882

  32. Haberman D, Estevez-Loureiro R, Benito-Gonzalez T et al (2022) Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction. Eur Heart J 43:641–650

    Article  PubMed  Google Scholar 

  33. Boudoulas KD, Paraskevaides I, Boudoulas H, Triposkiadis FK (2014) The left atrium: from the research laboratory to the clinic. Cardiology 129:1–1

    Article  PubMed  Google Scholar 

  34. Boudoulas H, Gravanis MB (1993) Valvular heart disease. In Cardiovascular Disorders: pathogenesis and pathophysiology. Mosby-Year Book, Inc, Gravanis MB, ed. pp 64–117

  35. Otto CM, Nishimura RA, Bonow RO et al (2021) 2020 ACC/AHA Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/ American Heart Association Joint Committee on clinical practice guidelines. Circulation 143:e35–e71

    PubMed  Google Scholar 

  36. Zeymer U, Alushi B, Noc N et al (2023) Influence of culprit lesion intervention on outcome in infasrct- related cardiogenic shock with cardiac arrest. F Am Coll Cardiol 81:1165–1176

    Article  Google Scholar 

  37. Russo A, Suri RM, Gredioni F et al (2008) Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture. Circulation 118:1528–2153

    Article  PubMed  Google Scholar 

  38. Lorusso R, Gelsomino S, De Cicco G et al (2008) Mitral valve surgery in emergency for severe acute regurgitation: analysis of postoperative results from a multicenter study. Eur J Cardio-Thoracic Surg 33:573–582

    Article  Google Scholar 

  39. Geis N, Raake P, Mereles D et al (2017) Percutaneous repair of severe mitral regurgitation secondary to chordae rupture in octogenarians using mitral clip. Interventional Cardiol 31:76–82

    Article  Google Scholar 

  40. Sultan I, Aranta-Michel E, Gleason TG et al (2018) Mitral valve surgery for acute papillary muscle rupture. J Cardiac Surg 33:844–848

    Article  Google Scholar 

  41. Jalil B, El-Kersh K, Frizzell J et al (2017) Impella percutaneous left ventricular assist device for severe acute ischemic mitral regurgitation as a bridge to surgery. BMJ Case Rep 2017:bcr2017219749

    Article  PubMed  PubMed Central  Google Scholar 

  42. Vandenbriele C, Balthazar T, Wilson J et al (2021) Left Impella device as bridge from cardiogenic shock with acute, severe mitral regurgitation to MitraClip-procedure: a new option for critically ill patients. Eu Heart J Acute Cardiovasc Care 10:415–421

    Article  Google Scholar 

  43. Parlow S, Di Santo P, Jung RG et al (2022) Transcatheter mitral valve repair for inotropic dependent cardiogenic shock-designed and rational of the CAPITAL MINOS trial. Am Heart J 254:81–87

    Article  PubMed  Google Scholar 

  44. Adamo M, Curello S, Chiari E et al (2017) Percutaneous edge-to- edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: as single center experience. Int J Cardiol 234:53–57

    Article  PubMed  Google Scholar 

  45. Mack M, Carroll JD, Thourani V et al (2021) Transcatheter mitral valve therapy in the United States: a report from the STS-ACT TVT registry. J Am Coll Cardiol 78:2326–2353

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, The Ohio State University, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA

    Konstantinos Dean Boudoulas & Harisios Boudoulas

  2. Department of Cardiology, Larissa University General Hospital, Larissa, Greece

    Filippos Triposkiadis

  3. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, USA

    Sara Koenig

  4. Tampa Heart, Tampa, FL, USA

    Konstantinos Marmagkiolis

  5. Department of Internal Medicine, University of South Florida, Tampa, FL, USA

    Konstantinos Marmagkiolis

  6. Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Cezar Iliescu

  7. Thessaloniki Research Heart Institute, Thessaloniki, Greece

    Antonios Pitsis

  8. Division of Cardiovascular Medicine, The Ohio State University, Columbus, USA

    Harisios Boudoulas

Authors
  1. Konstantinos Dean Boudoulas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Filippos Triposkiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara Koenig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Konstantinos Marmagkiolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cezar Iliescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonios Pitsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harisios Boudoulas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KDB and HB literature review, interpretation of data, writing first draft, critical revisions; FP, SK, KM, CI, and AP literature review, interpretation of data, writing, and critical revisions.

Corresponding author

Correspondence to Harisios Boudoulas.

Ethics declarations

Ethical approval

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boudoulas, K.D., Triposkiadis, F., Koenig, S. et al. Acute mitral regurgitation with and without acute heart failure. Heart Fail Rev 28, 1201–1209 (2023). https://doi.org/10.1007/s10741-023-10322-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-023-10322-5

Keywords

Search

Navigation