Post ectopic mitral regurgitation

Post ectopic mitral regurgitation

Long pause following an ectopic beat can produce a diastolic mitral regurgitation during left ventricular angiography. Abnormal sequence of activation can cause systolic mitral regurgitation during the ectopic beat due to papillary muscle dysfunction. Post ectopic mitral regurgitation can cause errors in interpretation during left ventriculography. The force of contrast injection, especially with the older single end hole catheters can cause ventricular ectopy when the jet strikes the ventricular wall.

Modern day left ventriculography is done invariably with pigtail catheters with multiple side holes. As the contrast moves out from multiple side holes in a radial fashion from opposite sides, the force of recoil is also distributed and cancelled out. The chance of inducing ventricular ectopy with such catheters is very rare. Earlier end hole catheters sometimes used to produce contrast staining of ventricular wall which used to induce frequent ventricular ectopy or even ventricular tachycardia.

Avoidance of ventricular ectopy during left ventriculography for evaluation of mitral regurgitation is of paramount importance. Repeat ventriculography should be done if ectopy is induced as even one or two ventricular premature contractions can cause underestimation or overestimation of valve regurgitation [1].

Reference

1. Rick A Nishimura, Blase A Carabello. Hemodynamics in the Cardiac Catheterization Laboratory of the 21st Century. Circulation. 2012 May 1;125(17):2138-50.