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Teachable Moment | Less Is More

Severe Mitral Regurgitation in Hypovolemic Shock Masquerading as Mitral Valve Perforation A Rising Tide Lifts an Anchor

Colin T. Phillips, MD1; Michael C. Gavin, MD1; Eli V. Gelfand, MD1
[+] Author Affiliations
1Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2016;176(4):433-435. doi:10.1001/jamainternmed.2016.0202.
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Extract

This Teachable Moment examines the effect of a simple leg raise (volume loading) on the dynamic left ventricular outflow tract and mitral regurgitation.

Article InformationCorresponding Author: Colin T. Phillips, MD, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (ctphilli@bidmc.harvard.edu).

Published Online: March 21, 2016. doi:10.1001/jamainternmed.2016.0202.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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Figure 1.
Transesophageal Echocardiogram Views of the Mitral Valve (MV) and Aortic Valves and Left Ventricular (LV) Outflow Tract

Views demonstrating the systolic anterior motion of the MV and mitral regurgitation (MR). A, Significant systolic anterior motion of the mitral valve nearly obliterating the left ventricular outflow tract (LVOT). B, Color Doppler of moderate MR due to the systolic anterior motion of the MV. LA indicates left atrium; V, ventricle.

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Figure 2.
Transesophageal Echocardiogram Views Following Passive Leg Lift

A, Reduced systolic anterior motion of the mitral valve and relief of the left ventricular outflow tract (LVOT) obstruction due to increased preload and left ventricular (LV) filling. B, Color Doppler with reduced mitral regurgitation (MR) mirroring the reduced systolic anterior motion of the mitral valve (MV). LA indicates left atrium; V, ventricle.

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