Acute mitral regurgitation due to short periods of ischemia during percutaneous transluminal coronary angioplasty: an angiographic study.
The frequency and severity of mitral regurgitation were investigated during a short period of ischemia (60 seconds) in patients undergoing elective percutaneous transluminal coronary angioplasty of single vessel disease. Thirty patients showed stenoses in the left anterior descending artery, 3 patients in the circumflex artery and 1 patient in the right coronary artery. Only patients with global and regional normal left ventricular function, and without collaterals reaching or filling the target vessel, were enrolled in the study. All patients suffered pain during occlusion of the vessel. Signs of mitral regurgitation of grade 1 could be documented angiographically in 9 patients and of grade 2 in 4 patients. In no patient mitral regurgitation of grades 3 or 4 was seen. A highly significant (P less than 0.001) decrease of global, as well as regional, left ventricular function could be documented during ischemia in all patients. The breakdown of wall motion was more pronounced in patients with mitral regurgitation, and reached statistical significance (P less than 0.05) in the apical and anterolateral segments. All patients with mitral regurgitation showed extended severely hypokinetic or akinetic wall segments adjacent to the anterior papillary muscle. There were no angiographic signs of mitral valvar prolapse or dilation of the mitral annulus. We concluded that transient mitral regurgitation is common during short periods of ischemia in humans, but of only minimal degree in the setting of single vessel disease. The mechanism is different from mechanisms in chronic ischemic incompetence of the mitral valve.
Prachar
H
H
Medical Department of Cardiology, Hospital Lainz, Vienna, Austria.
Dittel
M
M
Enenkel
W
W
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003251:Constriction, Pathologic; D003326:Coronary Circulation; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000150:complications; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011859:Radiography