The syndrome of acute mitral regurgitation -- clinical recognition, investigation and management
Chia, B.L.; Ee, B.; Tan, A.; Choo, M.; Tan, L.; Tan, N.C.; Singh, B.; Mah, E.P.; Quek, S.
Singapore Medical Journal 23(6): 291-298
1982
ISSN/ISBN: 0037-5675 PMID: 7167816 Document Number: 192087
The syndrome of acute mitral regurgitation due to either chordal or papillary muscle rupture usually presents dramatically with acute pulmonary edema and requires early diagnosis and surgical treatment. Here, experiences with 9 patients are described. Five patients (group 1 cases) with no known previous cardiac disease presented with sudden cardiac failure. Clinical examination revealed a loud apical pansystolic murmur with a 4th heart sound. The ECG of these 5 patients were normal and their chest X-rays showed either a normal sized heart or minimal cardiomegaly. The 4 patients in group 2 all had previous cardiac disease. They also presented with sudden onset of cardiac failure and apical systolic murmurs. Unlike the group 1 cases, considerable cardiomegaly detected clinically and radiologically was present in these patients. In 3 of the 9 patients in both group 1 and 2, the chordal rupture was due to infective endocarditis. Two-dimensional echocardiography is an excellent tool for confirming chordal rupture and was positive in 4 of the 5 patients studied. Left ventricular angiography showed severe mitral regurgitation in all 9 patients. All the patients could be stabilized on vigorous medical therapy and subsequently underwent surgery. Rupture of the chordae tendinae to the anterior and posterior mitral valve leaflet was seen in 4 patients each. In the last patient, rupture of both papillary muscles resulted in flail anterior and posterior valve leaflets. Valvuloplasty was carried out in 2 patients and valvular replacement in the remaining 7. All 9 patients improved significantly after operation, attesting to the excellent results which can be expected in this condition if surgery is not unduly delayed.