Acute mitral incompetence.

Abstract

SUMMARYWe have reported the occurrence of acute mitral incompetence in 22 patients. The mitral incompetence was considered to be secondary to ruptured chordæ tendineæ in 12 patients and to papillary muscle infarction in 10 patients. In three, the mitral leak was secondary to papillary muscle rupture.The clinical manifestations have been reviewed and attention drawn to the need to differentiate the signs of acute mitral incompetence from combined aortic and mitral valve disease or from muscular subaortic stenosis. The clinical signs, radiographs and hæmodynamic studies are all helpful in this diagnosis.It is important to recognize acute mitral incompetence so that appropriate treatment can be commenced. In those not responding adequately to a medical régime, surgical correction of the mitral incompetence should be considered. The results of the surgical treatment of acute mitral incompetence are reported in seven patients, there being a good result in four. A satisfactory outcome is more likely in those patients with ruptured chordæ and a previously normal myocardium. In patients with papillary muscle infarction and severe mitral incompetence, valve replacement may be required. Because of the underlying coronary disease, the outcome in this group will be less favourable.