1 From the Department of Cardiology, Cedars-Sinai Medical Center and the Department of Medicine, University of California, Los Angeles, California.
To assess the potential beneficial effects of vasodilator agents in patients with severe mitral regurgitation, sodium nitroprusside was administered intravenously at a rate of 16 to 100 µg/min in eight patients with clinically significant mitral regurgitation presumably due to dysfunction of the subvalvar apparatus. In all patients there was a decrease in the magnitude of the peak `V' wave (from 50 ± 4.5 to 19 ± 2.9 mm Hg) and in left ventricular filling pressure (33 ± 1.8 to 16 ± 1.4 mm Hg), together with a decreased intensity of the apical pansystolic murmur. There was a significant increase in forward cardiac index (2.2 ± 3.5 to 3.3 ± .47 liter/min/M2) and forward stroke volume index (23 ± 4.4 to 36 ± 6.6 ml/M2) along with a reduction in systemic vascular resistance (1802 ± 331 to 1102 ± 241 dynes/sec/cm-5). In the five patients in whom the therapy was continued, relief of symptoms of pulmonary venous congestion occurred. In the four patients in whom left ventricular volumes were determined angiographically, the observed increase in forward stroke volume was due to a reduction in the regurgitant fraction. These findings suggest that the use of vasodilator agents like nitroprusside can achieve the major objectives of treatment of patients with mitral regurgitation: an increase in forward stroke output, a reduction in regurgitant volume and a decrease in pulmonary venous pressure.
Submitted on March 27, 1973
© 1973 American Heart Association, Inc.
Beneficial Effects of Vasodilator Agents in Severe Mitral Regurgitation Due to Dysfunction of Subvalvar Apparatus
Key Words: Nitroprusside • Outflow impedance • Total stroke volume • Regurgitant volume
Accepted on May 14, 1973
This article has been cited by other articles:
 |
|
 |
|
  K. Chatterjee The Swan-Ganz Catheters: Past, Present, and Future: A Viewpoint Circulation, January 6, 2009; 119(1): 147 - 152. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Chatterjee, D. McGlothlin, and A. Michaels Analytic Reviews: Cardiogenic Shock with Preserved Systolic Function: A Reminder J Intensive Care Med, November 1, 2008; 23(6): 355 - 366. [Abstract] [PDF]
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]
|
|
|
|
 |
|
 R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Sekuri, O. Utuk, O. Bayturan, A. Bilge, Z. Kurhan, and T. Tavli Effect of losartan on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation Journal of Renin-Angiotensin-Aldosterone System, June 1, 2008; 9(2): 107 - 111. [Abstract] [PDF]
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]
|
|
|
|
|
|
M. Enriquez-Sarano, A.-J. Basmadjian, A. Rossi, K. R. Bailey, J. B. Seward, and A. J. Tajik Progression of mitral regurgitation: A prospective Doppler echocardiographic study J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1137 - 1144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hung, Y. Otsuji, M. D. Handschumacher, E. Schwammenthal, and R. A. Levine Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation: Physiologic insights from the proximal flow convergence technique J. Am. Coll. Cardiol., February 1, 1999; 33(2): 538 - 545. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Rosario, L. W. Stevenson, S. D. Solomon, R. T. Lee, and S. C. Reimold The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1819 - 1824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Steimle, L. W. Stevenson, C. Chelimsky-Fallick, G. C. Fonarow, M. A. Hamilton, J. D. Moriguchi, A. Kartashov, and J. H. Tillisch Sustained Hemodynamic Efficacy of Therapy Tailored to Reduce Filling Pressures in Survivors With Advanced Heart Failure Circulation, August 19, 1997; 96(4): 1165 - 1172. [Abstract] [Full Text]
|
|
|
|
|
|
M. Enriquez-Sarano, L. J. Sinak, A. J. Tajik, K. R. Bailey, and J. B. Seward Changes in Effective Regurgitant Orifice Throughout Systole in Patients With Mitral Valve Prolapse : A Clinical Study Using the Proximal Isovelocity Surface Area Method Circulation, November 15, 1995; 92(10): 2951 - 2958. [Abstract] [Full Text]
|
|
|
|
|
|
M. H. Crawford Acute Mitral Regurgitation J Intensive Care Med, December 1, 1986; 1(6): 329 - 335. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Gould, C. Gopalaswamy, F. Chandy, and O. Abdou Noninvasive Assessment of Left Ventricular Wall Stress in Chronic Congestive Heart Failure Patients Angiology, February 1, 1983; 34(2): 111 - 118. [Abstract] [PDF]
|
|
|
|
|
|
P. Esente, A. Giambartolomei, and G. G. Gensini The Use of Injectable Nitroglycerin in the Cardiac Catheterization Laboratory: Nitroglycerin in Cardiac Catheterization Angiology, May 1, 1982; 33(5): 319 - 324. [Abstract] [PDF]
|
|
|
|
 |
|
 G. L. Pierpont and R. C. Talley Pathophysiology of Valvar Heart Disease: The Dynamic Nature of Mitral Valve Regurgitation Arch Intern Med, May 1, 1982; 142(5): 998 - 1001. [Abstract] [PDF]
|
|
|
|
|
|
L. Gould, V.R. Reddy, S. Patel, G.I. Gomes, and W. H. Becker Noninvasive Assessment of Load Reduction in Chronic Congestive Heart Failure Patients Angiology, August 1, 1981; 32(8): 552 - 560. [PDF]
|
|
|
|
 |
|
 B. H. Greenberg and S. H. Rahimtoola Vasodilator Therapy for Valvular Heart Disease JAMA, July 17, 1981; 246(3): 269 - 272. [Abstract] [PDF]
|
|
|
|
|
|
L. Gould, C.V.R. Reddy, Bujung Zen, and B.K. Singh Effect of Nitroglycerin Ointment on Hemodynamics in Patients With Mitral Insufficiency Angiology, October 1, 1980; 31(10): 677 - 685. [Abstract] [PDF]
|
|
|
|
 |
|
 J. N. COHN and L. P. BURKE Nitroprusside Ann Intern Med, November 1, 1979; 91(5): 752 - 757. [Abstract] [PDF]
|
|
|
|
|
|
L. Gould and C.V.R. Reddy Hemodynamic Effects of Phentolamine in Mitral Stenosis and Congestive Cardiomyopathy Angiology, July 1, 1979; 30(7): 498 - 504. [PDF]
|
|
|
|
|
|
L. Gould, C.V. Ramana Reddy, S.G. Kim, and K.C. Oh Electrophysiologic Properties of Nitroprusside in Man Angiology, January 1, 1979; 30(12): 841 - 849. [Abstract] [PDF]
|
|
|
|
|
|
L. Gould, C.V.R. Reddy, S.G. Kim, and K.C. Oh Hemodynamic Effects of Phentolamine in Valvular Abnormalities Angiology, December 1, 1978; 29(12): 898 - 906. [PDF]
|
|
|
|
|
|
J. A. Franciosa, L. A. Nordstrom, and J. N. Cohn Nitrate Therapy for Congestive Heart Failure JAMA, August 4, 1978; 240(5): 443 - 446. [Abstract] [PDF]
|
|
|
|
|
|
J. R. Tobin The Treatment of Congestive Heart Failure: Digitalis Glycosides Are Still the Primary Mode of Therapy Arch Intern Med, March 1, 1978; 138(3): 453 - 454. [Abstract] [PDF]
|
|
|
|
|
|
J. A. FRANCIOSA, G. PIERPONT, and J. N. COHN Hemodynamic Improvement after Oral Hydralazine in Left Ventricular Failure: A Comparison with Nitroprusside Infusion in 16 Patients Ann Intern Med, April 1, 1977; 86(4): 388 - 393. [Abstract] [PDF]
|
|
|
|
|
|
K. CHATTERJEE, D. DREW, W. W. PARMLEY, S. C. KLAUSNER, J. POLANSKY, and B. ZACHERLE Combination Vasodilator Therapy for Severe Chronic Congestive Heart Failure Ann Intern Med, October 1, 1976; 85(4): 467 - 470. [Abstract] [PDF]
|
|
|
|
|
|
K. CHATTERJEE Vzasodilator Therapy for Heart Failure Ann Intern Med, September 1, 1975; 83(3): 421 - 423. [Abstract] [PDF]
|
|
|
|
|
|
W. Grossman, C. W. Harshaw, A. B. Munro, L. Becker, and L. P. McLaurin Lowered Aortic Impedance as Therapy for Severe Mitral Regurgitation JAMA, November 18, 1974; 230(7): 1011 - 1013. [Abstract] [PDF]
|
|