Ventriculo-atrial regurgitation following prosthetic replacement of the mitral valve: Angiocardiographic and hemodynamic findings ∗

Abstract

Partial detachment of a mitral ball-valve prosthesis, resulting in left ventriculo-atrial regurgitation, may be responsible for persistent symptoms of diminished cardiac reserve following mitral valve replacement. Such persistent regurgitation is difficult to detect and to differentiate by clinical means from other causes of residual disability, since the characteristic pansystolic murmur of mitral regurgitation is often absent. The present study reports the clinical findings, hemodynamic data, and the results of left ventricular cineangiocardiography in 18 patients following mitral valve replacement. All of the patients had persistent hemodynamic abnormalities, and in 17 the left atrial pressure was elevated. On cineangiocardiography, it was observed that some degree of ventriculo-atrial regurgitation always occurred with “normal” function of the prosthetic valve. However, the appearance of this type of regurgitation differed angiocardiographically from that caused by partial detachment of the prosthesis. The characteristics of regurgitation resulting from detachment of the valve were defined cineangiographically in 8 patients, and confirmed in 6 of these 8 patients, who were reoperated upon. In 6 other patients the clinical and hemodynamic abnormalities appeared to be due solely to abnormal function of the left ventricular myocardium. It is suggested that the diagnosis of ventriculoatrial regurgitation should be suspected and left ventricular cineangiocardiography should be performed in patients who fail to improve following mitral valve replacement or who exhibit abnormal cardiac dynamics at postoperative cardiac catheterization.