Posterior Medial Papillary Muscle Echocardiogram

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Fig. 11. Ruptured papillary muscle. (A) Transthoracic images a patient 5 d post-MI showed a mobile linear echodensity that ping-ponged between left atrium and left ventricle with each cardiac cycle (left panel). Attached at its end was the avulsed tip (head) of the posterior-medial papillary muscle. Right panel showed large postero-laterally directed MR jet as seen in from the apical four-chamber view. (B) Mid-esophageal views from patient showed the mobile tip of the dehisced papillary muscle (arrow in both panels) within the left atrium. Note the partial flail of the anterior mitral valve leaflet (left panel) with the resultant postero-laterally directed MR jet. (Please see companion DVD for corresponding video.)

Fig. 11. Ruptured papillary muscle. (A) Transthoracic images a patient 5 d post-MI showed a mobile linear echodensity that ping-ponged between left atrium and left ventricle with each cardiac cycle (left panel). Attached at its end was the avulsed tip (head) of the posterior-medial papillary muscle. Right panel showed large postero-laterally directed MR jet as seen in from the apical four-chamber view. (B) Mid-esophageal views from patient showed the mobile tip of the dehisced papillary muscle (arrow in both panels) within the left atrium. Note the partial flail of the anterior mitral valve leaflet (left panel) with the resultant postero-laterally directed MR jet. (Please see companion DVD for corresponding video.)

case presentation 5: rheumatic mitral regurgitation

A 39-yr-old female with known history of rheumatic heart disease and worsening shortness of breath was referred for an echocardiogram prior to consideration for percutaneous mitral balloon valvuloplasty.

Rheumatic heart disease is the major underlying cause of mitral stenosis. The postinflammatory

Table 4

Indicators for Poor Prognosis in MR

1. Symptoms of heart failure

2. Left ventricular ejection fraction (LVEF) < 50% with symptoms

3. Acute-onset MR

4. Acute flail of mitral valve leaflets

5. Significant MR accompanying acute myocardial infarction

Echo Lvef Mode

Fig. 12. (A) Mitral regurgitation in the setting of rheumatic heart disease is the result of structural distortion, thickening, and restricted leaflet motion. Mitral stenosis (MS) and aortic regurgitation (AR) were also present in this patient. (B) This color M-mode through the left atrium and ventricle in the same patient shows mixed mitral stenosis-mitral regurgitation jets.

Fig. 12. (A) Mitral regurgitation in the setting of rheumatic heart disease is the result of structural distortion, thickening, and restricted leaflet motion. Mitral stenosis (MS) and aortic regurgitation (AR) were also present in this patient. (B) This color M-mode through the left atrium and ventricle in the same patient shows mixed mitral stenosis-mitral regurgitation jets.

Table 5

Grading MR Severity: Recommended Parameters

Mild

Moderate

Severe

Structural parameters Left atrial size Left ventricular size Mitral leaflets and supporting complex

Doppler parameters Color jet area

(Niquist limit 50-60 cm/s)

Jet density - CW Jet contour - CW

Pulmonary vein flow - PW

Quantitative parameters

Vena contracta width (cm)

Regurgitant volume (mL/beat)

Regurgitant fraction (%)

EROA (effective regurgitant area orifice)

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