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PubMed1996

Mitral valve protrusion assessed by use of B-mode echocardiography in dogs with mitral regurgitation.

OBJECTIVE: To examine our hypothesis that changes of the mitral valve in dogs with mitral regurgitation lead to various degrees of protrusion of the cusp in individual dogs in systole. DESIGN: Assessing the mitral protrusion, using B-mode echocardiography in dogs with mitral regurgitation. ANIMALS: 33 dogs with chronic mitral regurgitation and 40 clinically normal dogs. PROCEDURE: The mitral valve was imaged in the right parasternal left ventricular long-axis view, and we measured the height (H) from the coaptation point or tip of the protruded cusp to the mitral annular plane. When the tip of the protruded cusp was located beyond the mitral annular plane extending into the left atrium, H was expressed as negative values. RESULTS: The H in clinically normal dogs was 3.7 +/- 0.8 mm. In dogs with mitral regurgitation, the mitral cusp protruded toward the left atrium to various degrees, and H was -0.7 +/- 1.9 mm (range, 2.9 to -5.0 mm). The 2 dogs in the latter group with the lowest H (-5.0 and -4.5 mm, respectively) presented typical mitral flail on B-mode images. The indices of left atrial and ventricular dimension (left atrial dimension/aortic dimension and left ventricular end-diastolic dimension/body weight, respectively) were significantly higher than those in the clinically normal dogs and were negatively correlated with H. CONCLUSION: The mitral valve in individual dogs with mitral regurgitation has different degrees of protrusion. The degree of protrusion might be related to the hemo-dynamic condition in mitral regurgitation.

Animals↗
PubMed2001

Mechanical properties of myxomatous mitral valves.

OBJECTIVE: We sought to characterize the mechanical properties of normal and myxomatous mitral valve tissues. METHODS: We tested 113 mitral valve sections from patients undergoing mitral valve repair or replacement for myxomatous mitral valve prolapse and sections from 33 normal valves obtained at autopsy. RESULTS: Myxomatous mitral valve leaflets were more extensible than normal leaflets when tested parallel to the free edge (41.2% +/- 18.5% vs 17.3% +/- 6.7% circumferential strain [mean +/- SD]; P <.001), as well as perpendicular to the free edge (43.2% +/- 19.4% vs 17.3% +/- 6.7% radial strain; P <.001). Myxoid leaflets were less stiff circumferentially (4.0 +/- 1.6 vs 6.1 +/- 1.4 kN/m; P <.001) and radially (4.5 +/- 1.1 vs 6.1 +/- 1.4 kN/m; P <.001) than normal leaflets. Leaflet strength, however, was similar in both groups. CONCLUSIONS: Myxomatous mitral valve leaflets are physically and mechanically different from normal mitral valve leaflets. They are more extensible and less stiff. Compared with chordae examined previously, however, they are affected much less. Myxomatous mitral valve disease may therefore affect the collagen in the chordae more severely than that in the leaflets.

Case-Control Studies↗
PubMed2002

Mitral valve repair for degenerative disease.

Degenerative mitral valve disease is the most common cause of mitral regurgitation in North America. Using techniques developed by Carpentier and others, up to 90% of degenerative mitral valves can be repaired. These valves are characterized by annular dilatation and chordal rupture or elongation; chordal changes are mainly localized to the posterior leaflet. The most common repair technique for posterior leaflet prolapse is quadrangular resection. When the leaflet is >1.5 cm long, a sliding repair is added to reduce the risk of systolic anterior motion. Anterior leaflet prolapse is usually treated by transfer of chords from the posterior leaflet or adjacent areas of the anterior leaflet. Other useful techniques for correction of anterior leaflet prolapse are creation of artificial chords and the Alfieri edge-to-edge repair. Chordal shortening is rarely employed as it jeopardizes repair durability. Annuloplasty accompanies all repairs. A posterior annuloplasty provides results equivalent to those obtained with a circumferential annuloplasty. Flexible annuloplasty has theoretical advantages, but clinical benefits have not been shown. After mitral valve repair for degenerative disease, 10-year freedom from reoperation is 93%. Risk of reoperation is increased by anterior leaflet prolapse, chordal shortening, failure to use an annuloplasty, and lack of intraoperative echocardiography. In the ideal situation, when posterior leaflet resection is corrected by quadrangular resection with annuloplasty and the result is confirmed by intraoperative echocardiography, the 10-year durability is 98%.

Female↗
PubMed1996

[Clinical experiences with mitral valve reconstruction].

Between October 1988 and December 1993, 433 patients with mitral valve insufficiency underwent mitral valve repair. Patient's age ranged from 13 to 82 years (mean age 59.5 years). Mitral valve insufficiency was due to degenerative disease in 192 patients (44%), ischemic disease in 102 (23%), rheumatic disease in 76 (18%) and other causes in 63 patients (15%). Most of the patients (337) were in functional class III or IV. The patients were divided into 3 functional groups: type I (normal leaflet motion) 141 patients (33%), type II (leaflet prolapse) 265 patients (61%) and type III (restricted leaflet motion) 27 patients (6%). Two patients were lost to follow-up for a total follow-up of 761 patients per year. The operative mortality was 2.5% for the total group, 0.4% for the group with isolated mitral valve insufficiency, 7.5% for the group with mitral valve repair associated with coronary artery bypass grafting and 2.9% for the group associated with tricuspid valve repair. At the time of the discharge, 71% of the patient at Doppler echocardiography showed no mitral regurgitation, 25.5%, 3% and 0.5% showed a mitral regurgitation grade 1,2 or 3 respectively. The 5-year actuarial survival was 84%. At 5 years, 96% of the patients were free from reoperation, 96% free from thromboembolism and 93% free from bleeding complications. Among the survivors 93% of the patients were in functional class I or II.

Actuarial Analysis↗
PubMed2005

Quality of life after mitral valve repair.

BACKGROUND AND AIM OF THE STUDY: Mitral valve repair for degenerative and ischemic mitral valve regurgitation has been shown to be a durable procedure. The study aim was to evaluate the quality of life of patients who had undergone mitral valve repair, and to compare it to that of an age- and gender-adjusted Finnish general population. METHODS: Among 130 late survivors after mitral valve repair, 109 (83.8%) answered the RAND-36 Health Survey questionnaire; these patients form the basis of the present study. RESULTS: The Wilcoxon test showed significantly higher mental health (p = 0.04) and pain scores (p = 0.015) and a lower role functioning/physical score (p = 0.008) in the study group. The scores of the other RAND-36 Health Survey variables of the study group were similar to those of the age- and gender-adjusted general population. The mean total score for the study group was 512 (median 532, IQR 360-678), compared to 522 (median 538, IQR 468-549) in the general population (p = 0.72) (only 95 patients were included in the analysis due to isolated missing scores). CONCLUSION: The quality of life of long-term survivors after mitral valve repair, as assessed by the RAND-36 Health Survey, is similar to that of an age- and gender-adjusted general Finnish population.

Aged↗
PubMed1978

[Late results of mitral valve prosthesis].

The late results of mitral valve prosthetics were studied in 100 patients one to six years after surgery. Survival which was estimated by the actuarial method was 79.4% (15 patients died 2 to 34 months after the operation). The data obtained confirm the effectiveness of mitral valve prosthetics by means of the Soviet made MKch--25 and MKch--27 protheses. The operation ensures normalization of hemodynamics. Thromboembolic complications and bacterial endocarditis still present a serious problem. Patients with an implanted mitral valve prosthesis should be kept under dispensary surveillance.

Adolescent↗
PubMed1996

Spectrum of structural abnormalities in floppy mitral valve echocardiographic evaluation.

Posterior displacement of the mitral valve with billowing into the left atrium has been the major echocardiographic criterion used for the diagnosis of mitral valve prolapse (MVP). However, the current criteria are limited by the influence of hemodynamic factors on the degree of prolapse, whereas complications such as mitral regurgitation, endocarditis, and need for surgery have been associated with redundancy or thickening of the leaflets. Sixty-eight normal subjects (mean age, 40 years; range, 18 to 76 years) were compared with 58 patients with MVP (mean age, 37 years, range, 18 to 83 years). Leaflet displacement across the annular plane in the parasternal long-axis view was mandatory for the diagnosis of MVP. Transthoracic echocardiographic measurements of anterior and posterior leaflet thickness, leaflet length, and chordal length were made from the parasternal long-axis view and the mitral annular diameter, from the apical four-chamber and two-chamber views. The MVP group had greater anterior thickness (4.1 +/- 0.4 mm vs 5.3 +/- 0.7 mm; p = 0.0001), posterior thickness (3.2 +/- 0.4 mm vs 4.7 +/- 0.9 mm; p = 0.0001), anterior length (22.8 +/- 2.0 mm vs 25.7 +/- 1.7 mm; p = 0.0001), posterior length (12.8 +/- 1.0 mm vs 15.7 +/- 2.5 mm; p = 0.0001), chordal length (25.6 +/- 2.7 mm vs 28.0 +/- 2.5 mm; p = 0.0001), and annular diameter (29.1 +/- 1.5 mm vs 31.3 +/- 2.6 mm; p = 0.0001). Of the MVP group, >80% had at least one abnormality identified and >50% had at least two abnormalities. In addition, patients with MVP with significant regurgitation had greater anterior thickness (5.2 +/- 0.7 mm vs 5.8 +/- 0.8 mm; p = 0.015), posterior thickness (4.5 +/- 0.9 mm vs 5.3 +/- 0.7 mm; p = 0.024), posterior length (15.1 +/- 1.6 mm vs 17.9 +/- 4.2 mm; p = 0.004), and annular diameter (36.0 +/- 2.0 mm vs 33.3 +/- 2.1 mm; p = 0.0001). The majority of patients with floppy mitral valves resulting in MVP have structural abnormalities that may be defined by echocardiography. A spectrum of floppy valve structure is demonstrated by echocardiography, with mitral regurgitation occurring more frequently in patients with multiple and more severe anatomic abnormalities. In addition to the presence of prolapse and regurgitation, the assessment of leaflet thickness, leaflet length, annular diameter, and chordal length is fundamental to the definition and stratification of patients with MVP associated with the floppy mitral valve.

Adolescent↗
PubMed1996

Serial change of mitral regurgitation after mitral valve repair: comparison of anterior with posterior leaflet lesions.

Mitral valve repair is an important operative procedure for correcting mitral regurgitation (MR). However, serial change of residual MR after operation has not been reported. Serial change of MR after mitral valve repair was evaluated by transesophageal color Doppler echocardiography (TEE). Twenty-six patients undergoing mitral valve repair for MR during 1987 to 1991 were examined by TEE just after operation, 6 months after operation, and late follow-up period (mean 3.7 years). Thirteen patients had a lesion of the anterior mitral leaflet before operation (group A). Thirteen patients had a lesion of the posterior mitral leaflet before operation (group P). The MR area was measured by TEE at each stage after operation. In group A, the MR area at late follow-up increased significantly compared with just after operation (1.1 vs 4.3 cm2, p < 0.001). In group P, the MR area at late follow-up did not increase significantly compared with just after operation (0.6 vs 1.3 cm2, p = NS). In conclusion, MR does not increase after mitral valve repair in patients with posterior mitral valve repair, but MR may increase at late follow-up after operation for anterior mitral valve prolapse.

Echocardiography↗
PubMed1993

Effects of preserving mitral apparatus on ventricular systolic function in mitral valve operations in dogs.

The mitral apparatus can affect left ventricular function through various mechanisms, such as the direct mechanical coupling between the mitral anulus and papillary muscle and the mitral annular contraction. To evaluate the relative contribution of these mechanisms, we investigated in five groups of 35 dogs that underwent open chest operations how preservation of the mitral apparatus affects left ventricular systolic function. We performed atriotomy in the first group. We sutured a prosthetic rigid ring around the mitral anulus in the second group. We replaced the mitral valve and preserved the anterior chordae in the third group, the posterior chordae in the fourth group, and no chordae in the fifth group. The postoperative percentage of recovery of ventricular function (as assessed by the slope of the end-systolic pressure-volume relation) from preoperative control values were 92.2% +/- 4.8%, 89.5% +/- 12.8%, 85.7% +/- 9.5%, 75.1% +/- 12.9%, and 61.3% +/- 8.0%, respectively. Preservation of the mitral apparatus significantly improved left ventricular function compared with that of conventional mitral valve replacement. The average relative contribution of the ventricular muscle to left ventricular function, the mitral anulus-papillary muscle continuity, and the mitral annular contraction were 66.5%, 30.6%, and 2.9%, respectively. We conclude that it is more beneficial to preserve the mitral apparatus in mitral valve replacement. The prosthetic ring does not detract from the functional benefit of the preservation of the mitral apparatus.

Animals↗
PubMed1999

Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic transesophageal echocardiography examination.

UNLABELLED: Mitral regurgitation (MR) is a major determinant of outcome in cardiac surgery. The location and mechanism of mitral lesions determine the approach to various repairs and their feasibility. Because of incomplete evaluations or change in patient condition, detailed intraoperative transesophageal echocardiography (TEE) examination of the mitral valve may be required. We hypothesized that a systematic TEE mitral valve examination would allow precise identification of the anatomic location and mechanism of MR in patients undergoing mitral surgery. We designed a systematic mitral valve examination consisting of six views: five-chamber, four-chamber, two-chamber anterior, two-chamber mid, two-chamber posterior and short-axis. We used this examination prospectively in 13 patients undergoing mitral valve surgery for severe MR and compared the results with the surgical findings. We then retrospectively interpreted 11 similar patients who had undergone intraoperative TEE studies before this examination. TEE correctly diagnosed the mechanism and precise location of pathology in 12 of 13 patients in the prospective group, but in only 6 of 10 patients in the retrospective group. TEE also correctly identified 75 of 78 mitral segments (96%) as being normal or abnormal. In the retrospective group, only 42 of 60 segments (70%) were correctly identified (P < 0.001). We conclude that this systematic TEE mitral valve examination improves identification of mitral segments and precise localization of pathologies and may also improve the diagnosis of the mechanism of MR. IMPLICATIONS: In this article, we describe how a systematic examination of the mitral valve by using transesophageal echocardiography allows identification of the different segments of the mitral valve, precise localization of pathology, and helps to diagnose the mechanism of mitral regurgitation. This is important in determining an approach to mitral valve repair and its feasibility.

Anesthesia↗
PubMed1992

Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance.

BACKGROUND: Standard mitral valve replacement (MVR) in patients with chronic mitral regurgitation consistently results in a decrease in postoperative left ventricular (LV) ejection performance. This fall in ejection performance has been attributed, at least in part, to unfavorable loading conditions imposed by the elimination of the low-impedance pathway for LV emptying into the left atrium. In contrast to standard MVR in which the chordae tendineae are severed, however, MVR with chordal preservation (MVR-CP) does not usually decrease LV ejection performance despite similar removal of the low-impedance pathway. The purpose of the present study was to define the mechanisms responsible for this discordance in postoperative ejection performance between MVR with and without chordal preservation. METHODS AND RESULTS: Echocardiography and sphygmomanometer blood pressures were obtained in 15 patients with pure chronic mitral regurgitation before and 7-10 days after mitral valve surgery. These measurements were used to calculate ventricular volume, wall stress, and ejection fraction. Seven patients underwent MVR with chordal transection (MVR-CT), and eight patients underwent MVR-CP. MVR-CT resulted in no postoperative change in LV end-diastolic volume, a significant increase in LV end-systolic volume, a significant increase in end-systolic stress, from 89 +/- 9 to 111 +/- 12 g/cm2 (p < 0.05), and a significant decrease in ejection fraction, from 0.60 +/- 0.02 to 36 +/- 0.02 (p < 0.05). In contrast, patients who underwent MVR-CP had a significant decrease in LV end-diastolic and end-systolic volumes. End-systolic wall stress actually fell from 95 +/- 6 to 66 +/- 6 g/cm2 (p < 0.05), and ejection fraction was unchanged (0.63 +/- 0.01 before and 0.61 +/- 0.02 after mitral valve surgery) instead of reduced. CONCLUSIONS: MVR-CT resulted in a decrease in ejection performance caused in part by an increase in end-systolic stress, which in turn increased end-systolic volume. Conversely, MVR-CP resulted in a smaller LV size, allowing a reduced end-systolic stress and preservation of ejection performance despite closure of the low-impedance left atrial ejection pathway.

Chordae Tendineae↗
PubMed1989

Non-myxomatous mitral valve prolapse: a clinical and pathological study.

Mitral valve specimens from 9 patients with severe mitral regurgitation due to mitral valve prolapse were examined. All belonged to the age group 10-30 years and had rapid progression of their illness, requiring early surgery. The histopathological examination of valve tissue revealed varying degrees of fibrosis, increased vascularity and absence of myxomatous degeneration. These patients may represent a distinct group of mitral valve prolapse, whose clinical course is different from those with typical myxomatous degeneration of the mitral valve.

Adolescent↗
PubMed2004

Tailored surgical therapy for acute native mitral valve endocarditis.

BACKGROUND AND AIM OF THE STUDY: Mitral valve repair has been shown superior to valve replacement for the treatment of non-infectious valve disease. The criteria and results of valve repair for native valve endocarditis are still being defined. The study aim was to examine the short- and long-term results of mitral valve repair and replacement for acute infective endocarditis and to define criteria for the use of each technique. METHODS: A total of 53 consecutive patients who presented with acute native mitral valve infective endocarditis (diagnosed less than six weeks before surgery) between January 1992 and June 2002 was retrospectively analyzed. RESULTS: Twenty-one patients (40%) underwent mitral valve repair, and 32 (60%) underwent valve replacement. Operative mortality was 0% for the repair group and 13% (4/32) for the replacement group (p = 0.14). Median follow up was 4 years (range: 6-108 months). At five years follow up, a median ejection fraction (EF) of 60% and mitral regurgitation (MR) grade of 1/4 was observed, with an overall late survival of 85% (19/21), in the repair group, while the replacement group had a median EF of 55% and an overall late survival of 73% (p = 0.73). Recurrent endocarditis occurred in 2/21 (10%) in the repair group and 1/32 (3%) in the replacement group (p = 0.34). CONCLUSION: Mitral valve repair is a safe and effective technique to treat acute native mitral valve infective endocarditis with favorable short- and long-term morbidity and mortality. Patients with advanced endocarditis and annular destruction require valve replacement. Mitral valve repair should be performed when technically feasible.

Acute Disease↗
PubMed1993

Evaluation of the role of coronary heart disease and left ventricular contractile function in systolic mitral valve displacement.

It has been suggested that systolic bulging of the mitral valve caused by ischaemia induced left ventricular dysfunction may ultimately lead to mitral valve prolapse, making coronary heart disease the most important cause of secondary mitral valve prolapse. The influence of coronary heart disease on systolic displacement of the mitral valve was assessed in 90 consecutive patients with chest pain who were evaluated with coronary angiography and ventriculography of the left ventricle. 22 patients had coronary heart disease affecting one vessel (one vessel disease, OVD), 35 patients had coronary heart disease affecting more than one vessel (multiple vessel disease, MVD), and 33 patients had normal coronary arteries. The prevalence of mitral valve bulging was also determined in 16 patients with dilatative cardiomyopathy (CMP). Prevalence of mitral valve bulging in patients with OVD was not significantly different from normal patients. Patients with MVD and CMP had a lower prevalence of mitral valve bulging than normal patients and patients with OVD (p < 0.001). When all patients were grouped according to their ejection fraction, regardless of their underlying disease, there was a positive correlation between prevalence of mitral valve bulging and ejection fraction (r = 0.98, p < 0.001). Patients with an ejection fraction of below 50% did not have mitral valve bulging. We conclude that coronary heart disease is not a cause of mitral valve bulging and, furthermore, that systolic mitral valve bulging may serve as indicator of good left ventricular contractile function.

Adult↗
PubMed1998

Estimation of mitral regurgitation with a hemielliptic curve-fitting algorithm: in vitro experiments with native mitral valves.

To date, studies on the mitral flow convergence method have used rigid, circular, or slit orifices to represent the regurgitant orifice. In this study, explanted porcine mitral valves, with the entire mitral apparatus preserved, were mounted in an in vitro model to reproduce the three-dimensional regurgitant orifice geometry while permitting close control and measurement of the experimental conditions. This experimental setup permitted the evaluation of the hemispheric and hemielliptic formulas under realistic physiologic conditions. In this study, a heart rate of 70 beats/min was used with cardiac outputs between 1.5 and 6 L/min. Peak regurgitant flow rates ranged from 7 to 16 L/min (regurgitant jet velocities ranged from 2 to 5.5 m/sec); peak aortic flow rates ranged from 9 to 30 L/min. Four native mitral valves were used for these studies for a total of 28 stages. Although the hemielliptic modification has previously shown success in vitro and computationally, it has not been used clinically because of difficulty imaging the flow convergence region in three orthogonal planes. A curve-fitting algorithm was developed to extract the hemielliptic dimensions from two standard ultrasound views by rotating the transducer 90 degrees. Improved agreement was obtained between true and calculated flow rates by the hemielliptic formula (y = 1.02 x + 0.29; r = 0.91) compared with the hemispheric formula (y = 1.18 x - 2.2; r = 0.66). This method provides accurate results with a realistic three-dimensional regurgitant orifice geometry and has the capability of being incorporated as a function key on an ultrasound machine for clinical application.

Algorithms↗
PubMed1998

Surgical repair of the congenitally malformed mitral valve in infants and children.

BACKGROUND: Mitral valve remodeling techniques were applied to 26 infants and children (mean age, 6.0 years, range, 0.4 to 15.9 years) with various forms of congenital mitral valve disease over a 7-year period. Patients with atrioventricular canal, L-transposition and single ventricle were excluded. Intraoperative transesophageal echocardiography (TEE) was utilized to assess the repair and guide the need for immediate intervention. METHODS: Twenty-one patients had mitral regurgitation: 10 with cleft anterior mitral leaflet, 7 with annular dilatation, 1 with normal leaflets with an obstructing cord, 2 with prolapsed leaflets and elongated cords, and 1 with restricted leaflet motion, normal papillary muscles, and shortened cords. Of the 5 mitral stenosis patients, 3 had supravalvular mitral ring, 1 had midvalvular mitral ring, and 1 had a parachute valve. Three of the mitral stenosis patients had additional stenotic lesions. Concurrent repair of associated lesions was performed in 21 patients (78%). RESULTS: Operative mortality was 3.8% (n = 1). There were no late deaths. Immediate rerepair in 4 patients resulted in improved function. All mitral stenosis patients improved. A total of 20 mitral regurgitation patients (95%) improved; 1 required mitral valve replacement. Mean follow-up is 31 months (range, 2 to 81 months). All patients are in New York Heart Association functional class I or II. CONCLUSIONS: Mitral valve repair can be successfully performed in infants and children with excellent short- and midterm results. Assessment using transesophageal echocardiography can guide the necessity for immediate rerepair to achieve improved function.

Adolescent↗
PubMed1988

[A new diagnostic criteria of mitral valve prolapse syndrome].

The diagnosis of mitral valve prolapse (MVP) should depend on the presence of significant mitral regurgitation or mitral complex abnormality as far as MVP is a diseased status. Concerning the echocardiographic diagnosis, the site of prolapse is difficult to determine correctly. In this study, Doppler color flow mapping was used to detect mitral regurgitation, and to decide the site of prolapse. Our new criteria of MVP include: (1) Phonocardiographic or auscultatory findings suggestive of mitral regurgitation or mitral complex abnormality. (2) A systolic bulging or an apparent systolic ballooning of the mitral valve by two-dimensional echocardiography. (3) A mitral regurgitant signal with an acceleration flow at the site of prolapse by Doppler color flow mapping.

Echocardiography↗
PubMed1983

Mitral valve prolapse in short-term experimental coronary occlusion: a possible mechanism of ischemic mitral regurgitation.

Experimental coronary occlusions were carried out in 12 closed-chest dogs to investigate the functional anatomic characteristics of the mitral valve complex during acute myocardial ischemia. Two-dimensional echocardiography was used to assess left ventricular function, the mitral valve complex, and left atrial size. Presence of mitral regurgitation was assessed by left ventricular contrast echocardiography. Thirty-seven coronary occlusions of up to 10 min in duration were carried out in proximal or distal locations in the left anterior descending and the left circumflex coronary arteries. Mitral regurgitation, which was mild in severity as judged by a small rise in pulmonary artery wedge pressures, was observed in 15 of 37 brief coronary occlusion experiments. Mitral valve prolapse was noted in all 15 experiments, as well as in four additional studies in which mitral regurgitation was not seen. The development of experimental mitral valve prolapse was explained by measurements that demonstrated a relative displacement of the papillary muscle tips toward the mitral orifice. We conclude that mitral valve prolapse is a common sequela of short-term coronary occlusion and is often associated with mild mitral regurgitation. Relative displacement of ischemic papillary muscles toward the mitral orifice appears to be a likely mechanism of acute ischemic mitral valve prolapse.

Animals↗