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Mitral Regurgitation Complicating Myocardial Infarction

  • Teerapat YingchoncharoenEmail author

Abstract

A 78-year-old woman had a past medical history of atrial fibrillation and acute ST-elevation inferior wall myocardial infarction 2 weeks prior to presentation. Her hospital course was complicated by ventricular tachycardia, cardiac arrest, and cardiogenic shock. After discharge to a rehabilitation facility, she was readmitted because of acute decompensated congestive heart failure. She successfully underwent mitral valve repair with coronary artery bypass grafting (Figs. 10.1, 10.2, 10.3, 10.4, 10.5, 10.6, and 10.7).

Keywords

Myocardial infarction Ruptured papillary muscle Ventricular septal rupture 

Supplementary material

Video 10.1

Transesophageal echocardiography (TEE) four-chamber view showed ruptured chordae tendineae of the posterior leaflet. The ruptured chordae are seen as a freely moving structure from the left ventricle to the left atrium during the cardiac cycle (AVI 5505 kb)

Video 10.2

A TEE zoom view of the mitral valve demonstrating flail of the posterior mitral leaflet with ruptured chordae (AVI 12633 kb)

Video 10.3

TEE zoom view of the mitral valve with color flow Doppler imaging demonstrating anteriorly directed mitral regurgitation jet (AVI 3203 kb)

Video 10.4

TEE at 60° showed ruptured chordae with papillary muscle head moving freely into the left atrium (AVI 9826 kb)

Video 10.5

TEE at 120° showed ruptured chordae with papillary muscle head moving freely into the left atrium (AVI 10014 kb)

Video 10.6

TEE at 120° with color flow Doppler imaging demonstrating anteriorly directed mitral regurgitation jet (AVI 1972 kb)

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Video 10.7 Three-dimensional (3D) reconstruction imaging of the mitral valve (surgical view) showing flail P3 segment of the mitral valve with ruptured papillary muscle (AVI 2454 kb)
Video 10.8

Transthoracic echocardiography (TTE) apical long-axis view showed anteroseptal wall hypokinesia. The zona coapta of the mitral valve was apically displaced (AVI 6579 kb)

Video 10.9

TTE apical long-axis view with color Doppler flow imaging showed a posteriorly directed mitral regurgitation jet (AVI 4392 kb)

Video 10.10

TTE apical four-chamber view showed anterolateral and apical hypokinesia. The posterior mitral leaflet has restricted motion throughout the cardiac cycle (AVI 6328 kb)

Video 10.11

TTE apical four-chamber view with color Doppler flow imaging showed posteriorly directed mitral regurgitation (AVI 4777 kb)

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Video 10.12 TTE apical four-chamber view, zoomed at LV and RV, showed severely impaired left ventricular systolic function with regional wall motion abnormalities in the left anterior descending coronary artery territory. An echo dropout is seen at the distal septum (AVI 562 kb)
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Video 10.13 TTE apical four-chamber view with color Doppler flow imaging, zoomed at LV and RV, showed left-to-right shunt during systole at the distal septum and significant mitral regurgitation (AVI 522 kb)
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Video 10.14 TTE apical four-chamber view showed apical displacement of the mitral valve zona coapta (AVI 951 kb)
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Video 10.15 TTE apical four-chamber view with color Doppler flow imaging showed significant mitral regurgitation (AVI 460 kb)

References

  1. 1.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin 3rd JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.PubMedCrossRefGoogle Scholar
  2. 2.
    Buckley MJ, Mundth ED, Daggett WM, Gold HK, Leinbach RC, Austen WG. Surgical management of ventricular septal defects and mitral regurgitation complicating acute myocardial infarction. Ann Thorac Surg. 1973;16:598–609.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineCleveland ClinicClevelandUSA

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