Cases of mitral valve causing mitral regurgitation: the MV ...

[Pages:15]2/19/2018

Cases of mitral valve causing mitral regurgitation: the MV prolapse spectrum

Judy Hung, MD Cardiology Division Massachusetts General Hospital

Boston, MA

Harvard Medical School

CASE

? Mr. M; 50 Year male presents to internist for annual physical. He feels well, no complaints ? Hyperlipdemia ? No tobacco; rare ETOH ? Well childhood ? Works as insurance broker

? Medications: Simvistatin 20 mg

? FH: Stroke in Elderly Grandmother ? Exam: 120/78; 70 bpm; CV-normal; no

murmur

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10 years later:

Feels well, recently retired but maintains active lifestyle-golf, part

time work at former company

Annual Exam: A new systolic murmur heard

2/19/2018

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AN ECHOCARDIOGRAM IS ORDERED Normal MV

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Summary of Echo Findings:

Mitral valve prolapse; predominantly of the posterior leaflet; Moderate MR LVID 52 mm; 30 mm; LVEF 77% LA 45 mm RVSP= 25 mmHg (assuming RAP of 10 mmHg)

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What to do?

1. Refer for mitral valve replacement 2. Refer for mitral valve repair 3. Treat with afterload reducing agents 4. Watchful waiting

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5 months later.......

He develops URI symptoms: cough, SOB, rhinitis; initial improvement with antibiotics; Then dyspnea with exertion and decreased exercise tolerance returns and worsens: stairs are now a problem; can't do yard work

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IMPRESSION: 1. No evidence of pulmonary edema. 2. Mild bilateral hilar prominence with suggestion of cranial redistribution of pulmonary vasculature suggesting pulmonary venous hypertension. However these findings canHaalsrvoarredsMulet dfriocaml School overcirculation caused by an ASD.

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AN ECHOCARDIOGRAM IS ORDERED

August, 2010

March, 2011

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March, 2011 ECHOCARDIOGRAM

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Summary of Echo #2

Mitral valve prolapse; posterior leaflet prolapse with flail and ruptured chord Severe MR LVID 54 mm; 34 mm; LVEF 73% RVSP= 47 mmHg (assuming RAP of 10 mmHg)

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Posterior Leaflet Flail (Transesophageal Echo)

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What happened to patient?

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Mitral Valve Prolapse

? Systolic displacement of one or both mitral leaflet into the left atrium of greater than 2 mm beyond annular plane. ?Occurs with or without mitral regurgitation ?Occurs with or without leaflet thickening ?In patients with leaflet thickening, myxomatous changes present on pathoanatomy Harvard Medical School

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Flail Leaflet = significant MR

Tip of the leaflet is in left atrium due to loss of convex shape of the

mitral leaflets; there is "eversion" of the normal convex shape of the

leaflet scallop

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Mitral Valve Chordal Anatomy

aka secondary

chordae

Provides basic structural support

Responsible for coaptation

aka primary chordae

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