Circulation, Vol 60, 170-176, Copyright © 1979 by American Heart Association
C Yoran, EL Yellin, RM Becker, S Gabbay, RW Frater and EH Sonnenblick
The dynamics of acute mitral regurgitation were studied in six open- chest
dogs in whom a portion of the anterior leaflet was excised. Phasic mitral
and aortic flows were measured electromagnetically and left ventricular
filling volume, regurgitant volume (RV) and forward stroke volume (SV) were
calculated. The systolic pressure gradient (SPG) between the left ventricle
(LV) and left atrium (LA) was obtained from high-fidelity pressure
transducers. The effective mitral regurgitant orifice area (MRA) was
calculated from the hydraulic equation of Gorlin. Volume infusion resulted
in significant increases in both left atrial and left ventricular
pressures; thus, the SPG was unchanged and the increase in RV was due
primarily to the increase in MRA. Angiotensin infused to raise arterial
pressure resulted in greater increments in left ventricular than left
atrial pressure, so that SPG rose significantly. The increase in RV was due
to increases in both MRA and SPG. Norepinephrine infusion increased
systolic left ventricular pressure and SPG, while left ventricular
end-diastolic pressure and left atrial pressure diminished. Despite a
significant increase in SPG, RV did not increase, due to a substantial
decrease in MRA. Thus, angiotensin and volume infusion induced a
substantial increase in regurgitation due to the increase in MRA, while
augmentation of contractility after norepinephrine infusion resulted in a
decrease in regurgitation through reduction of MRA. These findings support
the clinical view that maintaining a small LV with sustained myocardial
contractility will reduce mitral regurgitation. Alternatively, left
ventricular dilatation can enhance mitral regurgitation by increasing the
effective regurgitant orifice independent of SPG.
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Dynamic aspects of acute mitral regurgitation: effects of ventricular volume, pressure and contractility on the effective regurgitant orifice area
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