Eclipsed Mitral Regurgitation: A New Form of Functional Mitral Regurgitation for an Unusual Cause of Heart Failure with Normal Ejection Fraction
Eclipsed Mitral Regurgitation: A New Form of Functional Mitral Regurgitation for an Unusual Cause of Heart Failure with Normal Ejection Fraction
复制标题
隐性二尖瓣反流：一种新形式的功能性二尖瓣反流，用于治疗射血分数正常的异常原因心力衰竭
作者：
J. Aviérinos;F. Thuny;L. Tafanelli;S. Renard;Virginie Chalvignac;E. Guedj;M. Lambert;J. Quilici;J. Bonnet;M. Enriquez;G. Habib
背景：在无心外膜冠状动脉狭窄的情况下，短暂性功能性二尖瓣反流(MR)从未被报道为射血分数(EF)正常的心力衰竭(HF)的原因。结果：超声心动图对急性心衰患者在开始治疗前的超声心动图表现可以识别出3例EF正常但在心力衰竭发作期间有一过性大量功能磁共振的患者。在所有患者中，尽管EF正常，没有可检测到的左心室(LV)重构，尽管冠状动脉没有明显狭窄，但由于两叶突然极端的心尖帐篷，完全缺乏粘连，因此发生了大量的MR。在所有患者中，MR都是由注射甲基麦角新碱触发的，并且是自发的或在硝酸甘油注射后可逆的，使患者在两次心力衰竭发作之间保持正常的超声心动图。在两名患者中，长期服用钙通道阻滞剂防止了MR和HF的复发，而在一名患者中，二尖瓣最终被替换。结论：尽管EF正常、无左室重构且无冠状动脉狭窄，但二尖瓣叶突发性可逆性心尖遮盖可继发剧烈的MR和急性心力衰竭。这种非典型的功能性MR在LVEF正常的患者中是一种罕见的心力衰竭机制。
Background: Transient functional mitral regurgitation (MR) has never been reported as a cause of heart failure (HF) with normal ejection fraction (EF) in the absence of epicardial coronary artery stenosis. Results: Performance of echocardiography in patients with acute HF before initiation of HF medical treatment allowed identification of three patients with normal EF but transient massive functional MR during the HF episode. In all patients, massive MR occurred as a consequence of sudden extreme apical tenting of both leaflets with total lack of coaptation, despite normal EF and absence of detectable left ventricular (LV) remodeling, and despite absence of significant stenosis on coronary arteries. In all patients MR was triggered by methylergonovine injection and was reversible either spontaneously or after nitroglycerine administration, leaving patients with normal echocardiogram between HF episodes. In two patients, long-term administration of calcium channel blockers prevented recurrences of MR and HF, whereas in one, mitral valve was eventually replaced. Conclusion: Sudden reversible apical tenting of mitral leaflets with subsequent torrential MR and acute HF can occur despite normal EF, absence of pre-existing LV remodeling and absence of coronary artery stenosis. This atypical type of functional MR is an unusual mechanism of HF in patients with normal LVEF.
影响因子：
37.8
作者：
Senni, M;Tribouilloy, CM;Redfield, MM
通讯作者：
Redfield, MM
影响因子：
158.5
作者：
Gandhi, SK;Powers, JC;Little, WC
通讯作者：
Little, WC
急性后壁心肌梗死后，乳头肌不协调而不是环形面积增加促进二尖瓣反流。
DOI：
--
发表时间：
1997
期刊：
Circulation.
影响因子：
--
作者：
Gorman3rd,JH;Jackson,BM;Gorman,RC;Kelley,ST;Gikakis,N;EdmundsJr,LH
通讯作者：
EdmundsJr,LH