[Regional lung edema in acute mitral valve insufficiency following chordae tendineae rupture with prolapse of the posterior mitral valve leaflet].
An unilateral or predominantly lobar pulmonary edema is an unusual clinical or radiological finding, often misdiagnosed as one of the more common causes of focal lung disease. We report 2 cases of a regional pulmonary edema caused by the acute onset of a severe mitral insufficiency after the rupture of chordae tendinae resulting in a prolaps of the posterior mitral leaflet. In both cases the regional pulmonary edema was initially misdiagnosed as a pneumonic infiltration, which delayed the cardiological diagnostical procedures and the surgical intervention. The mechanism of the regional edema is an excentric recurgitation jet into the left atrium, which is usually directed to the orifice of the right upper lobe pulmonary vein which increases the hydrostatic vascular pressure in the corresponding lung segment. For the confirmation of the diagnosis, transesophageal echogradiographic is helpful in documenting the direction of the regurgitant flow and detecting differential gradients between the right and left pulmonary venous systems. The pulmonary infiltrations, which persisted for several weeks, disappeared within a few days after surgical mitral-valve-reconstruction in both cases.
Mauser
Manfred
M
Klinikum Lahr, Medizinische Klinik, Abteilung Kardiologie. Manfred-Mauser@t-online.de
Billmann
Peter
P
Wiedemer
Bernhard
B
Ennker
Jürgen
J
Fleischmann
Dietrich
D
D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis; D002815:Chordae Tendineae / Q000293:injuries* / Q000473:pathology; D003937:Diagnosis, Differential; D004452:Echocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology; D008945:Mitral Valve Prolapse / Q000175:diagnosis* / Q000209:etiology; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000209:etiology; D012422:Rupture, Spontaneous; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed