Images in Clinical Medicine
Severe Mitral Regurgitation
N Engl J Med 2000; 343:1386November 9, 2000
- Article
Figure 1 A 45-year-old woman with end-stage renal disease was seen for acute bacterial endocarditis. Echocardiographic study revealed marked mitral regurgitation with a large vegetation on the atrial side of the anterior leaflet of the mitral valve. At coronary angiography, a 30 percent stenosis of the proximal left anterior descending coronary artery and a 70 percent stenosis of the midportion of the right coronary artery were evident. Left ventriculography revealed normal systolic function with grade III/IV mitral regurgitation. The hemodynamic findings were of particular interest. A pulmonary-artery tracing (Panel A) revealed an elevated pulmonary-artery pressure, with a peak early systolic pressure of approximately 70 mm Hg (white arrow) followed by a V wave, which further elevated the pulmonary-artery pressure (black arrow). The pulmonary-capillary wedge pressure (PCWP) tracing (Panel B) was characterized by a V wave (white arrow) that ranged from 64 to 78 mm Hg. The left ventricular diastolic pressure (LVDP) curve shows that the pressure in the left ventricle was normal from the onset of diastole to the beginning of the A wave (upper black arrow). With atrial contraction, however, there was a marked increase in pressure of 24 mm Hg (the area between the two black arrows). The normal pressure during most of diastole probably explains why the patient did not have pulmonary edema.
Brent Wisse, M.D.
Allan D. Sniderman, M.D.
Royal Victoria Hospital, Montreal, QC H3A 1A1, Canada
