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Erschienen in: Heart Failure Reviews 5/2023

06.07.2023

Acute mitral regurgitation with and without acute heart failure

verfasst von: Konstantinos Dean Boudoulas, Filippos Triposkiadis, Sara Koenig, Konstantinos Marmagkiolis, Cezar Iliescu, Antonios Pitsis, Harisios Boudoulas

Erschienen in: Heart Failure Reviews | Ausgabe 5/2023

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Abstract

Acute severe mitral regurgitation (MR) is rare, but often leads to cardiogenic shock, pulmonary edema, or both. Most common causes of acute severe MR are chordae tendineae (CT) rupture, papillary muscle (PM) rupture, and infective endocarditis (IE). Mild to moderate MR is often seen in patients with acute myocardial infarction (AMI). CT rupture in patients with floppy mitral valve/mitral valve prolapse is the most common etiology of acute severe MR today. In IE, native or prosthetic valve damage can occur (leaflet perforation, ring detachment, other), as well as CT or PM rupture. Since the introduction of percutaneous revascularization in AMI, the incidence of PM rupture has substantially declined. In acute severe MR, the hemodynamic effects of the large regurgitant volume into the left atrium (LA) during left ventricular (LV) systole, and in turn back into the LV during diastole, are profound as the LV and LA have not had time to adapt to this additional volume. A rapid, but comprehensive evaluation of the patient with acute severe MR is essential in order to define the underline cause and apply appropriate management. Echocardiography with Doppler provides vital information related to the underlying pathology. Coronary arteriography should be performed in patients with an AMI to define coronary anatomy and need for revascularization. In acute severe MR, medical therapy should be used to stabilize the patient before intervention (surgery, transcatheter); mechanical support is often required. Diagnostic and therapeutic steps should be individualized, and a multi-disciplinary team approach should be utilized.
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Metadaten
Titel
Acute mitral regurgitation with and without acute heart failure
verfasst von
Konstantinos Dean Boudoulas
Filippos Triposkiadis
Sara Koenig
Konstantinos Marmagkiolis
Cezar Iliescu
Antonios Pitsis
Harisios Boudoulas
Publikationsdatum
06.07.2023
Verlag
Springer US
Erschienen in
Heart Failure Reviews / Ausgabe 5/2023
Print ISSN: 1382-4147
Elektronische ISSN: 1573-7322
DOI
https://doi.org/10.1007/s10741-023-10322-5

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