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Archives of cardiovascular diseases
Volume 102, n° 11
pages 797-798 (novembre 2009)
Doi : 10.1016/j.acvd.2009.06.007
Received : 24 May 2009 ;  accepted : 29 June 2009
Diastolic atrioventricular regurgitation
Régurgitation diastolique atrioventriculaire
 

Alberto Bouzas-Mosquera , Ana García-Campos, Nemesio Álvarez-García
Department of Cardiology, Hospital Universitario A Coruña, As Xubias, 84, 15006, A Coruña, Spain 

Corresponding author. Fax: +34 981178258.

Keywords : Diastolic mitral regurgitation, Atrioventricular block

Mots clés : Régurgitation mitrale diastolique, Bloc atrioventriculaire


An 84-year-old man with a history of hypertension was referred for echocardiography because of shortness of breath. A transthoracic echocardiogram showed normal left ventricular ejection fraction, mild concentric left ventricular hypertrophy and mild mitral, aortic and tricuspid regurgitation. Colour Doppler, colour M-mode and continuous-wave Doppler recordings of the transmitral flow also revealed retrograde flows from the left ventricle into the left atrium (Figure 1A–C; Video 1) and from the right ventricle into the right atrium (Figure 1D–E; Video 2) during diastole, which define diastolic mitral and tricuspid regurgitation. Transmitral pulsed-wave Doppler (Figure 1F) also disclosed complete dissociation of mitral “E” and “A” waves, and a 12-lead electrocardiogram confirmed the diagnosis of third-degree atrioventricular block. A single-chamber permanent pacemaker was subsequently implanted without complications.



Figure 1


Figure 1. 

(A) Colour Doppler (apical 4-chambers view), (B) colour M-mode and (C) continuous-wave Doppler of transmitral flow demonstrating diastolic mitral regurgitation (arrows). (D) Colour Doppler (apical 4-chambers view) and (E) continuous-wave Doppler of transtricuspid flow showing diastolic tricuspid regurgitation (arrows). (F) Pulsed-wave Doppler of transmitral flow demonstrating complete atrioventricular dissociation.

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Atrioventricular conduction abnormalities are a well-known cause of diastolic atrioventricular regurgitation. Other potential aetiologies include severe acute aortic regurgitation and restrictive ventricular physiology. In patients with atrioventricular block of any degree, an appropriately timed ventricular systole may not occur at the end of atrial systole; in these cases, the increase in left ventricular diastolic pressure following atrial systoles – particularly in patients with a non-compliant left ventricle – may result in transmitral pressure gradient inversion during atrial relaxation, and mid or late diastolic mitral regurgitation may develop. The same pathophysiological mechanism accounts for the development of diastolic tricuspid regurgitation, which frequently accompanies diastolic mitral regurgitation.

Conflicts of interest

None.


Appendix A. Supplementary data

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 Supplementary Video 1 
Supplementary Video 1. 

Colour Doppler (apical 4-chambers view) showing diastolic mitral regurgitation.

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 Supplementary Video 2 
Supplementary Video 2. 

Colour Doppler (apical 4-chambers view) showing diastolic tricuspid regurgitation.



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