'Continuously regurgitating mitral valve': systolic and diastolic mitral regurgitation in a case of severe aortic regurgitation and complete heart block

When Is Mitral Regurgitation Not Just Systolic?: A Case of Near-Continuous Mitral Regurgitation

A 30-year-old man presented with symptomatic severe chronic aortic regurgitation, first-degree atrioventricular block, and near-continuous mitral regurgitation. Surgical intervention, including aortic root replacement and mitral valve repair, was successful, highlighting the close relationship between valvular diseases and emphasizing the importance of comprehensive assessment for optimal management.

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series

Background

Diastolic mitral regurgitation (DMR) is a type of functional mitral regurgitation. Its occurrence in the diastolic phase of cardiac cycle renders DMR an easily ignored entity. Confusing it with systolic mitral regurgitation occasionally happens. The reversal of left atrioventricular pressure gradient during diastole and the incomplete closure of mitral valve are the essential conditions for DMR. Diastolic mitral regurgitation develops under various situations, where the mechanisms of diastolic reversal of left atrioventricular pressure gradient differ.

Case summary

Patient 1 was a 50-year-old man diagnosed with 2:1 second-degree atrioventricular block (AVB). Patient 2 was a 70-year-old man diagnosed with first-degree AVB. Patient 3 was a 66-year-old man diagnosed with atrial fibrillation with long intermission and occasional atrial flutter with unequal conduction. Patient 4 was a 54-year-old woman diagnosed with dilated cardiomyopathy with complete left bundle branch block. Patient 5 was a 36-year-old man diagnosed with severe acute aortic regurgitation secondary to subacute bacterial endocarditis.

Discussion

Although the degree of DMR is relatively mild, its appearance generally prompts further clinical considerations. The appreciation of DMR has an incremental value for diagnosing and evaluating the underlying cardiovascular disease.