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• W1982142443 abstract "I 1963, Burch et al 1,2 reasoned that infarction of a papillary muscle causing failure to contract during ventricular ejection would result in mitral valve prolapse during the latter half of systole. This concept was developed to explain the timing of the murmur observed in ischemic mitral regurgitation (MR), which is frequently midto late systolic. However, experimentally induced isolated papillary muscle damage, ischemia, and infarction have repeatedly failed to produce MR. Also, MR caused by prolapse is not observed clinically in acute myocardial infarction or ischemia. Instead, similar to functional MR in idiopathic dilated cardiomyopathy, the mitral leaflets have been found to be apically displaced, showing incomplete leaflet closure. This has been attributed to dyskinesia or distortion of the region of the left ventricle from which the papillary muscles arise, displacing the papillary muscles and thus restricting leaflet closure. Nevertheless, the theory of papillary muscle dysfunction causing prolapse has survived even into recent editions of cardiology textbooks. One of the reasons may be the lack of an alternative explanation for the late systolic murmur in ischemic MR. Such an explanation may be found in the pattern of phasic regurgitant orifice area variation during systole, which reflects the underlying mechanism of MR. In idiopathic dilated cardiomyopathy, echocardiographic recordings of the proximal flow convergence region during MR have demonstrated a distinct biphasic pattern of flow and orifice area variation: a decrease during left ventricular contraction, an increase during ventricular relaxation. We hypothesized that the pattern of regurgitant orifice area variation in ischemic MR due to inferoposterior wall motion abnormalities will be similar, because the observed geometric substrate of regurgitation—apical tenting of the mitral valve—suggests a similar mechanism. In particular, we sought to demonstrate that the phenomenon of late systolic murmur can be explained by a late systolic increase in regurgitant orifice area and flow, a variant of the biphasic pattern of functional MR, and that it is related to mitral leaflet tethering and not mitral valve prolapse." @default.
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• W1982142443 date "2002-08-01" @default.
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• W1982142443 title "Mechanism of mitral regurgitation in inferior wall acute myocardial infarction" @default.
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• W1982142443 doi "https://doi.org/10.1016/s0002-9149(02)02469-4" @default.
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