Circulation, Vol 76, 777-785, Copyright © 1987 by American Heart Association
S Izumi, K Miyatake, S Beppu, YD Park, S Nagata, N Kinoshita, H Sakakibara and Y Nimura
The aim of the present study was to elucidate the mechanisms of mitral
regurgitation accompanying myocardial infarction. Severity and site of
mitral regurgitation was evaluated by the real-time two-dimensional Doppler
flow imaging technique in 81 patients with old myocardial infarction. The
incidence of mitral regurgitation did not depend on the region of
infarction. There was, however, a close relationship between the site of
regurgitation and the region of infarction. In patients with mitral
regurgitation spurting from the posteromedial area of the valve, the
inferior wall was involved in infarction without exception and in some of
these patients, the posteromedial papillary muscle was also found to be
affected by myocardial infarction; in those with regurgitation spurting
from the anterolateral area, the anterior wall showed asynergy. On the
other hand in patients with mitral regurgitation spurting from the central
area, the region of infarction varied. In these patients, however, the
larger the diameter of the mitral anulus, the more severe the grade of
regurgitation. The extent of asynergy was another factor related to the
severity of mitral regurgitation. Both longitudinally and transversely,
broad infarction leads to the enlargement of the mitral anulus. However,
even if the mitral anulus is not so dilated, severe involvement of either
commissural area results in severe mitral regurgitation from the same
commissural side. Thus, there are two major causative factors of mitral
regurgitation: (1) asynergy of the papillary muscle or the ventricle that
results in mitral regurgitation located in the commissural area of the same
side as asynergy, and (2) enlargement of mitral anulus, which results in
regurgitation from the central area of the orifice.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography
National Cardiovascular Center, Research Institute and Hospital, Osaka, Japan.
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