Secondary Mitral Regurgitation and Systemic Hypertension

¹ Cardiac Laboratory and Department of Radiology, the Negev Central Hospital, Beersheva; The Department of Pathology and the Department of Cardiac Surgery, Hadassah University Hospital, Jerusalem, Israel

Six patients are reported with heart failure, secondary mitral insufficiency and systemic hypertension. The hypertension was labile, frequently accentuated during cardiac failure, although recorded, as well, during periods of compensation. The normotensive periods in all patients were unrelated to the antihypertensive therapy. Five underwent hemodynamic studies: the results revealed severe pulmonary hypertension, with impaired left ventricular function; the incompetence was graded moderate to "large." Four patients were operated on: one survived longer than seven months. The mitral valve was normal in all. Heart failure was not improved by surgery. Postoperative hemodynamic studies were similar to those prior to operation, despite normal function of the prostheses. The mitral regurgitation was attributed to distortion of the spatial relationships between the papillary muscles and the mitral valve. The effects of systemic hypertension on mitral regurgitation are discussed. The present study suggests that patients with secondary mitral incompetence with tall V waves and elevated left ventricular filling pressures would not benefit from valve replacement, in particular those with disease below the mitral atrioventricular ring, such as hypertension or cardiomyopathy.