Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Острая ишемическая митральная регургитация у пациентов с передним и задним инфарктом миокарда

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Link: Clinical Physiology of Blood Circulaiton. 2011; (): -

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Abstract

The assumption that development of ischemic mitral regurgitation depends on the localization of necrotic focus was a guide for studying pathophysiological mechanisms of regurgitation in patients with anterior and posterior myocardial infarction (MI). Material and methods. 140 patients aged between 36 and 81 years admitted to the cardiac reanimation unit with a diagnosis «acute Q-myocardial infarction» during the first 24 hours since the onset of the disease were examined. Anterior myocardial infarction was revealed in 74 (52.9%) patients, posterior infarction - in 66 (47.1%). Entry criteria were acute Q-myocardial infarction, ischemic mitral regurgitation, intact leaflets of mitral valve, chordate and papillary muscles. Systolic apical shift of the point of leaflets closure, area of the systolic apical deflexion of the mitral valve leaflets, contractility of the mitral valve fibrous ring, systolic apical shift of the posterior papillary muscle during the standard Echo-CG study were analyzed. Ischemic mitral regurgitation values were determined with PISA-technique and quantitative Doppler-EchoCG. Results. The shift of posterior medial papillary muscle associated with posterior myocardial infarction has significant effect on the value of systolic apical deflection of the valvular leaflets (β= 0,46 ± 0,06; p=0,00003). Determination coefficient for linear regressive model was 0.59. Significant impact of neither of the factors studied on the value of systolic apical deflexion of mitral valve leaflets was revealed in the patients with acute anterior myocardial infarction. Conclusion. Ischemic mitral regurgitation develops in patients in the acute period of posterior myocardial infarction due to the shift of posterior medial papillary muscle and chordae fixation point, interfering with valve leaflets closure. Apical systolic tension of both leaflets of mitral valve due to the shift of papillary muscles from the fibrous ring area and formation of regurgitation opening occurs in the patients with anterior myocardial infarction due to local change of the left ventricle shape and its spherification.

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