Motion of the interatrial septum in acute mitral regurgitation. Clinical and experimental echocardiographic studies.

Abstract

The interatrial septal echocardiograms from 15 patients with acute mitral regurgitation due to ruptured chordae tendineae were compared with those from 14 normal subjects. On the cross-sectional echocardiogram, the interatrial septal configuration in patients with chordal rupture showed a characteristic pattern in which the interatrial septum (IAS) was flat or slightly convex toward the left atrium at end-diastole and became markedly convex toward the right atrium at end-systole. On the M-mode echocardiogram, the interatrial septal amplitude was greater in patients with chordal rupture (12.4 +/- 1.9 mm) than in normal subjects (9.4 +/- 0.9 mm). Systolic fluttering of the IAS was found in five of 10 patients with rupture of the chordae attached to the posterior mitral leaflet. This finding was thought to be specific for acute mitral regurgitation due to ruptured chordae to the posterior mitral leaflet. After operation, the amplitude of the IAS became normal or diminished and systolic fluttering of the IAS disappeared. Animal experiments performed to clarify the mechanism of these findings showed that increased systolic motion of the IAS resulted from an increased in the systolic left atrial-to-right atrial pressure gradient due to acute mitral regurgitation. The systolic fluttering of the IAS was thought to represent a jet stream against the IAS due to rupture of the chordae tendineae to the lateral half of the posterior mitral leaflet. We conclude that the interatrial septal echocardiogram reflects the hemodynamic changes due to acute mitral regurgitation and direction of the regurgitant jet against the IAS. This finding may prove to be important in diagnosing acute mitral regurgitation secondary to ruptured chordae tendineae.