Skip to main content

Functional Mitral Regurgitation in the Critically Ill

  • Conference paper
Intensive Care Medicine
  • 1329 Accesses

Abstract

Functional mitral regurgitation is the consequence of left ventricular systolic dysfunction in the presence of an anatomically normal mitral valve. Systolic left ventricular failure is often the cause of congestive heart failure, which is a frequent reason for admission to the intensive care unit (ICU). The most frequent cause of left ventricular dysfunction is ischemic heart disease. Both the ventricle and the mitral valve apparatus are involved in the pathogenesis of functional mitral regurgitation. The mitral valve is a complex apparatus, composed of the mitral valve leaflets, the chordae tendineae, papillary muscles, and the related regional area of the ventricular wall (Fig. 1). Malfunction of one or more components of this apparatus engenders improper functioning of the mitral valve.

The anatomy of the normal mitral valve. The different segments as used by cardiac surgeons, have been indicated.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Cohn LH, Kowalker W, Bhatia S, et al (1988) Comparative morbidity of mitral valve repair versus replacement for mitral regurgitation with and without coronary artery disease. Ann Thorac Surg 45: 284–290

    CAS  PubMed  Google Scholar 

  2. Gomez-Doblas JJ, Schor J, Vignola P, et al (2001) Left ventricular geometry and operative mortality in patients undergoing mitral valve replacement. Clin Cardiol 24: 717–722

    Article  CAS  PubMed  Google Scholar 

  3. Lamas GA, Mitchell GF, Flaker GC, et al (1997) Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators. Circulation 96: 827–833

    CAS  PubMed  Google Scholar 

  4. Lee R, Haluska B, Leung DY, Case C, Mundy J, Marwick TH (2005) Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation. Heart 91: 1407–1412

    Article  CAS  PubMed  Google Scholar 

  5. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al (2005) Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med 352: 875–883

    Article  CAS  PubMed  Google Scholar 

  6. 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 

  7. Taams MA, Gussenhoven EJ, Cahalan MK, et al (1989) Transesophageal Doppler color flow imaging in the detection of native and Bjork-Shiley mitral valve regurgitation. J Am Coll Cardiol 13: 95–99

    Article  CAS  PubMed  Google Scholar 

  8. Carpentier A, Chauvaud S, Fabiani JN, et al (1980) Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 79: 338–348

    CAS  PubMed  Google Scholar 

  9. Nwasokwa O, Camesas A, Weg I, Bodenheimer MM (1989) Differences in left ventricular adaptation to chronic mitral and aortic regurgitation. Chest 95: 106–110

    Article  CAS  PubMed  Google Scholar 

  10. Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ (2000) Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: A quantitative clinical study. Circulation 102: 1400–1406

    CAS  PubMed  Google Scholar 

  11. Yoshida K, Yoshikawa J, Yamaura Y, et al (1990) Value of acceleration flows and regurgitant jet direction by color Doppler flow mapping in the evaluation of mitral valve prolapse. Circulation 81: 879–885

    CAS  PubMed  Google Scholar 

  12. Hung J, Papakostas L, Tahta SA, et al (2004) Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target. Circulation 110: II85–90

    Article  PubMed  Google Scholar 

  13. Poelaert J, Schmidt C, Colardyn F (1998) Transoesophageal echocardiography in the critically ill. Anaesthesia 53: 55–68

    Article  CAS  PubMed  Google Scholar 

  14. Poelaert JI, Schupfer G (2005) Hemodynamic monitoring utilizing transesophageal echocardiography: The relationships among pressure, flow, and function. Chest 127: 379–390

    Article  PubMed  Google Scholar 

  15. Otsuji Y, Handschumacher MD, Schwammenthal E, et al (1997) Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 96: 1999–2008

    CAS  PubMed  Google Scholar 

  16. Edvardsen T, Urheim S, Skulstad H, Steine K, Ihlen H, Smiseth OA (2002) Quantification of left ventricular systolic function by tissue doppler echocardiography: Added value of measuring pre-and postejection velocities in ischemic myocardium. Circulation 105: 2071–2077

    Article  PubMed  Google Scholar 

  17. Amà R, Segers P, Roosens C, Claessens T, Verdonck P, Poelaert J (2004) Effects of load on systolic mitral annular velocity by tissue Doppler imaging. Anesth Analg 99: 332–338

    PubMed  Google Scholar 

  18. Berger M, Haimowitz A, Van Tosh A, Berdoff R, Goldberg E (1985) Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 6: 359–365

    Article  CAS  PubMed  Google Scholar 

  19. Quiles J, Garcia-Fernandez MA, Almeida PB, et al (2003) Portable spectral Doppler echocardiographic device: overcoming limitations. Heart 89: 1014–1018

    Article  CAS  PubMed  Google Scholar 

  20. Dini FL, Conti U, Fontanive P, et al (2007) Right ventricular dysfunction is a major predictor of outcome in patients with moderate to severe mitral regurgitation and left ventricular dysfunction. Am Heart J 154: 172–179

    Article  PubMed  Google Scholar 

  21. Aklog L, Filsoufi F, Flores KQ, et al (2001) Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation 104:I68–75

    Article  CAS  PubMed  Google Scholar 

  22. Czer LS, Maurer G, Bolger AF, DeRobertis M, Chaux A, Matloff JM (1996) Revascularization alone or combined with suture annuloplasty for ischemic mitral regurgitation. Evaluation by color Doppler echocardiography. Tex Heart Inst J 23: 270–278

    CAS  PubMed  Google Scholar 

  23. Bach D, Deeb M, Bolling S (1995) Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation. Am J Cardiol 76: 508–512

    Article  CAS  PubMed  Google Scholar 

  24. Bolling SF (2002) Mitral reconstruction in cardiomyopathy. J Heart Valve Dis 11 (Suppl 1): S26–31

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Poelaert, J. (2009). Functional Mitral Regurgitation in the Critically Ill. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92278-2_51

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92278-2_51

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92277-5

  • Online ISBN: 978-0-387-92278-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics