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[Postoperative acute mitral regurgitation. Unexpected finding after minor non-cardiac surgery].
Anaesthesist. 2008 Oct; 57(10):976-81.A

Abstract

This report describes the case of a 59-year-old man who was scheduled for general anesthesia with propofol, sufentanil and sevoflurane for removal of a metal implant. The patient was classified as American Society of Anesthesiologists (ASA) II status because of an asymptomatic mitral valve prolapse and medically treated arterial hypertension. During induction of narcosis a pulsoxymetrically measured inadequate increase in oxygen saturation after preoxygenation was noticed and a moderate respiratory obstruction occurred intraoperatively, but anesthesia was uneventfully completed and the patient was extubated. However, 3 h later the patient developed severe dyspnea, hypoxia, tachycardia and arterial hypotension. Physical examination revealed a new grade 4/6 systolic murmur radiating to the axilla and X-ray showed bilateral pulmonary edema. Neither electrocardiographic nor biochemical manifestations of acute myocardial infarction were identified but transthoracic echocardiography revealed fluttering of the posterior leaflet of the mitral valve with grade III regurgitation and dilation of the left atrium. Coronary angiography was normal and left ventriculography confirmed severe mitral regurgitation. Mitral valve repair was successfully performed 22 h after presentation of symptoms. Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 75% of the population. The etiology of mitral valve insufficiency which can be caused by pathologic changes of one or more of the components of the mitral valve, including the leaflets, annulus, chordae tendineae, papillary muscles, or by abnormalities of the surrounding left ventricle and/or atrium are discussed. Rupture of mitral chordae tendineae is infrequent and causes acute hemodynamic deterioration and needs corrective surgery. Valve replacement should be performed only if mitral valve repair is not possible. Echocardiography is an invaluable tool in determining the severity of regurgitation, the integrity of the mitral valve apparatus, the extent of left ventricular enlargement, and the ejection fraction. Acute mitral valve regurgitation caused by a rupture of chordae tendineae should be considered in the differential diagnosis of perioperative acute pulmonary edema.

Authors+Show Affiliations

Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 München, Deutschland. k.wagner@lrz.tum.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

ger

PubMed ID

18607554

Citation

Wagner, K J., et al. "[Postoperative Acute Mitral Regurgitation. Unexpected Finding After Minor Non-cardiac Surgery]." Der Anaesthesist, vol. 57, no. 10, 2008, pp. 976-81.
Wagner KJ, Unterbuchner C, Bogdanski R, et al. [Postoperative acute mitral regurgitation. Unexpected finding after minor non-cardiac surgery]. Anaesthesist. 2008;57(10):976-81.
Wagner, K. J., Unterbuchner, C., Bogdanski, R., Martin, J., Kochs, E. F., & Tassani-Prell, P. (2008). [Postoperative acute mitral regurgitation. Unexpected finding after minor non-cardiac surgery]. Der Anaesthesist, 57(10), 976-81. https://doi.org/10.1007/s00101-008-1409-8
Wagner KJ, et al. [Postoperative Acute Mitral Regurgitation. Unexpected Finding After Minor Non-cardiac Surgery]. Anaesthesist. 2008;57(10):976-81. PubMed PMID: 18607554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Postoperative acute mitral regurgitation. Unexpected finding after minor non-cardiac surgery]. AU - Wagner,K J, AU - Unterbuchner,C, AU - Bogdanski,R, AU - Martin,J, AU - Kochs,E F, AU - Tassani-Prell,P, PY - 2008/7/9/pubmed PY - 2009/2/21/medline PY - 2008/7/9/entrez SP - 976 EP - 81 JF - Der Anaesthesist JO - Anaesthesist VL - 57 IS - 10 N2 - This report describes the case of a 59-year-old man who was scheduled for general anesthesia with propofol, sufentanil and sevoflurane for removal of a metal implant. The patient was classified as American Society of Anesthesiologists (ASA) II status because of an asymptomatic mitral valve prolapse and medically treated arterial hypertension. During induction of narcosis a pulsoxymetrically measured inadequate increase in oxygen saturation after preoxygenation was noticed and a moderate respiratory obstruction occurred intraoperatively, but anesthesia was uneventfully completed and the patient was extubated. However, 3 h later the patient developed severe dyspnea, hypoxia, tachycardia and arterial hypotension. Physical examination revealed a new grade 4/6 systolic murmur radiating to the axilla and X-ray showed bilateral pulmonary edema. Neither electrocardiographic nor biochemical manifestations of acute myocardial infarction were identified but transthoracic echocardiography revealed fluttering of the posterior leaflet of the mitral valve with grade III regurgitation and dilation of the left atrium. Coronary angiography was normal and left ventriculography confirmed severe mitral regurgitation. Mitral valve repair was successfully performed 22 h after presentation of symptoms. Mitral regurgitation is a common finding on echocardiography, seen to some degree in over 75% of the population. The etiology of mitral valve insufficiency which can be caused by pathologic changes of one or more of the components of the mitral valve, including the leaflets, annulus, chordae tendineae, papillary muscles, or by abnormalities of the surrounding left ventricle and/or atrium are discussed. Rupture of mitral chordae tendineae is infrequent and causes acute hemodynamic deterioration and needs corrective surgery. Valve replacement should be performed only if mitral valve repair is not possible. Echocardiography is an invaluable tool in determining the severity of regurgitation, the integrity of the mitral valve apparatus, the extent of left ventricular enlargement, and the ejection fraction. Acute mitral valve regurgitation caused by a rupture of chordae tendineae should be considered in the differential diagnosis of perioperative acute pulmonary edema. SN - 1432-055X UR - https://www.unboundmedicine.com/medline/citation/18607554/[Postoperative_acute_mitral_regurgitation__Unexpected_finding_after_minor_non_cardiac_surgery]_ L2 - https://dx.doi.org/10.1007/s00101-008-1409-8 DB - PRIME DP - Unbound Medicine ER -