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Gepubliceerd in: Netherlands Heart Journal 12/2021

Open Access 17-08-2021 | Image Puzzle – Answer

Left ventricular haemodynamic effects in a patient with endocarditis

Auteurs: M. A. W. Habets, S. Bouwmeester

Gepubliceerd in: Netherlands Heart Journal | Uitgave 12/2021

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Answer

Echocardiography showed severe aortic regurgitation (AR) with diastolic mitral regurgitation (MR). Under normal conditions, a negative pressure gradient from left ventricle (LV) to left atrium (LA) during diastole keeps a forward blood flow through the mitral valve. Diastolic MR occurs due to reversal of the pressure gradient between LV and LA. Severe acute AR causes volume overload and high left ventricular end-diastolic pressure (LVEDP). When the LVEDP rises above the atrial pressure, the mitral valve leaflets approach each other. This results in incomplete mitral valve closure and end-diastolic MR before the LV contracts [1]. The diastolic regurgitant volume is usually small due to a low ventricle-atrial pressure gradient, with a far lower flow velocity than systolic MR [1, 2].
Fig. 1 shows the diastolic MR. The first white line in panel B indicates the start of the diastolic MR which merges into a systolic MR at the second white line. The time between those lines is the Q‑Mc time, the time between the Q wave and closure of the mitral valve. Because of the high LVEDP in this patient, the mitral valve closes during diastole before LV contraction, and the Q‑Mc time becomes negative (−80 ms).
It is important to recognise diastolic MR in patients with aortic regurgitation since it implies a severe haemodynamic state that requires emergency surgery. The patient underwent a successful emergency aortic valve replacement. The culture of the native aortic valve was positive for Capnocytophaga canimorsus, a commensal bacterium in the saliva of dogs. Antibiotics were continued intravenously for 6 weeks after surgery. The patient recovered after a rehabilitation period and the diastolic MR disappeared.

Conflict of interest

M.A.W. Habets and S. Bouwmeester declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Literatuur
1.
go back to reference Li Q, Liu Y, Zuo W, et al. Mechanisms, features, and significance of diastolic mitral regurgitation: a case series. Eur Heart J Case Rep. 2020;4:1–8. PubMedPubMedCentral Li Q, Liu Y, Zuo W, et al. Mechanisms, features, and significance of diastolic mitral regurgitation: a case series. Eur Heart J Case Rep. 2020;4:1–8. PubMedPubMedCentral
2.
go back to reference Sisu RC, Vinereanu D. Different mechanisms for diastolic mitral regurgitation illustrated by three comparative cases. Echocardiography. 2011;28:476–9. CrossRef Sisu RC, Vinereanu D. Different mechanisms for diastolic mitral regurgitation illustrated by three comparative cases. Echocardiography. 2011;28:476–9. CrossRef
Metagegevens
Titel
Left ventricular haemodynamic effects in a patient with endocarditis
Auteurs
M. A. W. Habets
S. Bouwmeester
Publicatiedatum
17-08-2021
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 12/2021
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-021-01616-0